Essay Sample on Implementing Safeguarding and Personalisation in Social Work

Abstract

Summary

This paper reports on part of a research study carried out in three local authority adult social care departments in England, which explored links between adult safeguarding and personalisation. The study included statistical analysis of data on safeguarding referrals and the take up of personal budgets and qualitative interviews with managers, social workers, other staff working on safeguarding and with service users. The paper reports the findings from 16 interviews with managers and social workers, highlighting their perspectives and experiences.

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Findings

Five main themes emerged from our analysis: contexts and risk factors; views about risks associated with Direct Payments, approaches to minimising risk; balancing risk and choice; and weaving safeguarding and personalisation practice. Social workers identified similar ranges and kinds of risks to those identified in the national evaluation of Individual Budgets. They described a tension between policy objectives and their exercise of discretion to assess and manage risks. For example, some described how they would discourage certain people from taking their personal budget as a Direct Payment or suggest they take only part of a personal budget as a Direct Payment.

Application

This exploratory study supports the continued need for skilled social workers to deliver outcomes related to both safeguarding and personalisation policies. Implementing these policies may entail a new form of 'care and control', which may require specific approaches in supervision in order to ensure good practice is fostered and positive outcomes attained.

Keywords

Personalisation; Direct Payments; Personal Budgets; Safeguarding; Social Work

Introduction

Personalization has been a prominent policy aspiration of the English Department of Health (DH) in recent years (DH 2008, Carr, 2012, DH, 2010b). The Care Act 2014 continues this policy emphasis, requiring local authorities to offer personal budgets to all those eligible for publicly funded social care. However, personalisation is defined in a number of ways. First, it may be seen as the creation of support tailored to individual needs, offering greater flexibility, choice and control over care and support than traditional services (Carr 2012). It has also been argued that personalisation, particularly the use of personal budgets and Direct Payments or cash-for-care, reflects a neoliberal agenda of reducing public sector expenditure and increasing commercial transactions that offer consumer choice at the expense of more universal entitlement and citizenship (Daly, 2012; Lymbery, 2014). Furthermore, personalisation has been implemented in the context of means-testing and high eligibility thresholds at a time when diminishing numbers of people are receiving local authority funded services (Fernandez et al. 2013). This may suggest the individual has to take on more responsibility for the size and shape of care. As Slasberg and Beresford (2015) note, this trend leads to substantial unacknowledged unmet need.

However, Needham (2010) cites some research claiming that there is a 'potential for personalization to deliver cost-savings, through getting users to be more creative in their use of funds' (Needham, 2010, p136). Local authorities may therefore exert pressure on care managers to increase numbers of people on Direct Payments, which may lead to increased risk and some individuals struggling to organise and manage care. Lloyd (2010) argues that such consequences arise from an individualistic conception of choice and control, rather than acknowledging the centrality of relationships and an ethic of care.

A distinction is often made between 'person-centred care', meaning providing choice and control for individuals, and 'personalisation', representing the policy focus on Resource Allocation Systems, Personal Budgets and marketisation (Beresford et al, 2011; Woolham et al, 2015). The development of Direct Payments can be seen as part of a greater transfer of responsibility and risk from the state to the service user for the choices they make and their consequences (Ferguson, 2007). This paper examines some of the implications of this development of 'responsibilisation', reflecting neo-liberal theory where individuals are seen as self-directing and autonomous (Bondi, 2005, Clarke et al, 2007), in the context of risk and safeguarding imperatives.

There is little research on the impact of personalisation on safeguarding practice (for exceptions, see Manthorpe et al 2009; Hunter et al 2013). This paper presents findings from a qualitative interview study that sought professionals' perspectives, experiences and responses to balancing the sometimes conflicting demands of personalisation and safeguarding. Interviews were undertaken as part of a recently completed study that aimed to identify the impact of Direct Payments and personal budgets on safeguarding referrals and to explore practice approaches to managing risks in supporting people to use Direct Payments and personal budgets safely. The study explored the speculative concerns raised by local authority and other professionals in the context of earlier opinions and debates, such as views about personalisation improving or jeopardising safeguarding (Poll et al. 2005; Williams 2010; Warin 2010; Richards and Ogilvie, 2010), which has been also highlighted by users and carers (Anonymous 2008; James 2008; Jupp 2008) and contributors to the government's review of the policy guidance on adult safeguarding, No Secrets (DH 2010b).

Findings from interviews with professionals are presented and discussed in light of the themes raised in the literature, such as: the benefits and risks of self-directed support (Hunter et al, 2013); the power relationships implicit in Direct Payments (Leece, 2010); and the reported reluctance of some groups to report potentially abusive or neglectful care provided by family carers (Bowes et al. 2008). It concludes by discussing the degree of convergence between personalisation and safeguarding, which the earlier evaluation of Individual Budgets identified as initially operating largely on 'parallel tracks' (Manthorpe et al., 2009) and which potentially remains a contested area of practice (Schwehr 2010; SCIE 2010).

The Benefits and Risks of Personalisation

There is a substantial international literature on the use of personalised care models, which involve the monetising of need and individualised purchasing of support (Manthorpe et al. 2014) although eligibility may be restricted by impairment or age. In England, the currently dominant cash-for-care model is personal budgets, as recently confirmed by the Care Act 2014. These offer eligible individuals increased control over the use of allocated money. They can be deployed in different ways: as a Direct Payment, where service users entirely or partly manage their personal budget as a Direct Payment; paid to a third party (an 'indirect payment'), usually a family member, who manages the budget on behalf of the individual; or wholly managed by a care manager or social worker, which is known as a managed Personal Budget, which some have argued offers only 'minor increases in opportunities for personalisation and choice' (Rabiee et al, 2013: p3). It is the government's intention that Direct Payments become the main form of deployment of personal budgets (DH 2010a).

There is much evidence about the positive impact of Direct Payments for certain groups of people, although similar evidence has not been found for managed personal budgets (Slasberg and Beresford, 2015). Outcomes for older people have been found to be less positive than for others (Netten et al., 2012). However, take up of Direct Payments remains low, especially amongst older people; only 15 per cent of older people receiving publicly funded social care take up a Direct Payment (ADASS, 2014).

Manthorpe et al. (2009) found that many practitioners and managers had concerns about the negative consequences of Individual Budgets (the precursor to personal budgets) for some people. Fears were expressed that using unregulated care workers or relatives may leave disabled or older people at greater risk of abuse (including neglect, physical and financial abuse/exploitation) or of receiving poorer quality support than people in receipt of conventional regulated services. Such fears are widely shared (Leece, 2010; Ferguson, 2007). Direct Payment holders are permitted to pay relatives (who live outside the home) to provide care and support and relatives are able to act as proxies by holding the Direct Payment when the adult concerned is not able to do so, for reasons such as severe dementia. Both of these developments may increase vulnerability to financial and other forms of abuse, as adult safeguarding managers have warned (Manthorpe and Samsi, 2013). Earlier research, however, suggests that people using Direct Payments and employing Personal Assistants (PAs) may report less abuse or poor quality care than those using conventional, council-commissioned services (Adams and Godwin, 2008), although this may be due more to low reporting levels rather than an indication of less abuse. Furthermore, some commentators have proposed that safeguarding is enhanced by greater choice and control (Tyson, 2010).

Methods and Data

The study took place from 2012 to 2014. It involved a review of Safeguarding Adults Boards' Annual Reports (Manthorpe et al, 2015), analysis of national and local data and interviews with professionals and service users. The study's findings are reported in Stevens et al (2015).

Conclusion

This paper draws on semi-structured interviews with professionals working in three selected English local authorities. The three sites were chosen to represent different types and size of authority: one Metropolitan borough, one rural Shire county and one city council. Two had specialist safeguarding teams that undertook some or all safeguarding work. In the third site responses to safeguarding concerns were undertaken by any social worker. The size of the sites' general population's ranged from 200,000 - 500,000.

We interviewed 14 professionals (six social workers, five team managers and three senior managers) and two elected council members. Of these participants, only social workers have regular extended contact with service users, undertaking assessments and reviews. Team managers may have occasional contact, possibly only in resolving problems or in relation to safeguarding referrals. Senior managers have less contact still, again mainly when chairing meetings or possibly through consultative activities in relation to policy and practice (which may also be attended by elected members).

To preserve anonymity, quotations from the elected members have been labelled as 'Senior Managers', in the Findings Section. Table 1 presents some demographic details about sites and participants. While there was a mix of gender, we will refer to all participants as 'she' in order t...