Stephen Martineau

Support workers in social care in England: a scoping study

This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.

Articulating the Improvement of Care Standards: The Operation of a Barring and Vetting Scheme in Social Care

The vetting and barring scheme known as the POVA (Protection of Vulnerable Adults) List established in England and Wales by the Care Standards Act (2000) was intended to provide greater assurance about the quality of social care for adults. This article discusses referrals to the POVA List in the period 21 May 2004 to 17 November 2006, details of which were made available to the researchers. These comprised 5,294 cases. Further data relating to the investigation process were provided through drawing on all material supplied in a purposively selected sample of 298 referrals. These have been analysed and findings are reported here in respect of referrals and prior disciplinary action, interactions with local and national agencies and the involvement of the police. What happened to the referrals and the length of time for decisions about Listing are also reported. The article concludes with some policy recommendations for the future of the scheme and sets this in the context of regulation.

‘In our experience’: Chairing and commissioning Serious Case Reviews in adult safeguarding in England

• Summary: The article reports findings from an audit of Serious Case Reviews into the death or harm of a vulnerable adult in England. Serious Case Reviews may be undertaken by local authorities in partnership with other agencies. There is little government guidance and practice appears variable. • Findings: Interviews were undertaken in 2007 with persons who had been appointed to Chair Serious Case Reviews and with those who commissioned such Reviews or managed the process. The findings confirm the aspiration of such Reviews to be opportunities for learning from mistakes, if any, and to thereby offer greater safeguards for vulnerable adults. In practice however, the conduct of such Reviews may be difficult if there is a lack of cooperation, a lack of resources and if there is little opportunity to share findings and recommendations outside the locality. • Application: This study supports the sharing of Serious Case Reviews to encourage learning from mistakes and missed opportunities to safeguard vulnerable adults. It also found agreement among those with experience in such Reviews that greater guidance on conduct and collaboration would be welcome.

Deciding to Move to a Care Home: The Shared Territory of Advocacy and Social Work Support

A scoping review maps the range of literature in a particular field and identifies where gaps in the evidence base may lie. The article reports a scoping review of literature in relation to advocacy and the decision to enter a care home in England, examining material published in English from 2000 to 2008 relating to the UK context and social work practice. Developments in decision-making related to mental capacity in England and Wales, with the introduction of advocacy on a statutory footing, may impact on the role of social workers. The implications of these developments are discussed in relation to making a decision to move to a care home in later life, to social work practice and in ascertaining the difference that advocates might make to this decision. The review concludes that there may be a need for greater attention to moves between homes and to people who positively want to move to a care home.

Weighing the evidence: a case for using vignettes to elicit public and practitioner views of the workings of the POVA vetting and barring scheme

This article describes research investigating the steps involved in recommending to the Secretary of State for Health whether a care worker should be included on the Protection of Vulnerable Adults (POVA) list, which records individuals barred from working and volunteering with vulnerable adults in England and Wales.The aims of the study were to investigate patterns of referrals to the list; factors associated with the collection of evidence to present to the Minister and to detail the operation of the list.The article focuses on the preliminary part of the research that covered discussion groups with purposive sample of older people, managers and staff during which a vignette approach was used to explore their perspectives.

The potential uses and abuses of a power of entry for social workers in England: a re-analysis of responses to a government consultation

Purpose Whether social workers should have a power of entry in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk is a topical question in England. The purpose of this paper is to present the findings of a re-examination of relevant sections of the 2012 Government Safeguarding Power of Entry Consultation. Design/methodology/approach Re-analysis of responses to question three of the 2012 Government’s Safeguarding Power of Entry Consultation was undertaken in late 2015-early 2016. The consultation submissions were located and searched for information on views of the prevalence of the situations where access to an adult at risk (with decision-making capacity) is being hindered by a third party and the nature of examples where a new power of entry might be considered appropriate by consultation respondents. Findings The majority of respondents to the consultation generally reported that situations when a new power of entry would be required were not encountered regularly; however a minority of respondents stated these situations occurred more frequently. Examples of situations where third parties appeared to be hindering access were given across the different categories of adults at risk and types of abuse and current practices were described. Respondents observed that the risks of excessive or inappropriate use of any new powers needed to be considered carefully. Originality/value This re-analysis sheds light on the prevalence and circumstances of the problems encountered about access to adults at risk. The legal framework of adult safeguarding continues to be of interest to policy makers, researchers and practitioners.

Parliamentary arguments on powers of access - the Care Bill debates

Purpose Opinion is divided on whether a new power of entry should be introduced for social workers in cases where individuals seem to be hindering safeguarding enquiries for community-dwelling adults at risk in England who have decision-making capacity. The purpose of this paper is to investigate the prevalence and circumstances of situations where access to an adult at risk is denied or difficult and what helps those in practice. The study consists of a literature review, a survey of adult safeguarding managers and interviews with social care staff in three case studies of local authorities. As part of the contextual literature review, during 2014 the authors located parliamentary debates on the subject and this paper reports on their analysis. Design/methodology/approach Following approaches were used in historical research, documentary analysis was carried out on transcripts of parliamentary debates available online from Hansard, supplemented by other materials that were referenced in speeches and set in the theoretical context of the representations of social problems. Findings The authors describe the content of debates on the risks and benefits of a new right to access for social workers and the role of parliamentary champions who determinedly pursued this policy, putting forward three unsuccessful amendments in efforts to insert such a new power into the Care Act 2014. Research limitations/implications There are limits to a focus on parliamentary reports and the limits of Hansard reporting are small but need to be acknowledged. However, adult safeguarding research has surprisingly not undertaken substantial analyses of political rhetoric despite the public theatre of the debate and the importance of legislative initiatives and monitoring. Originality/value This paper adds to the history of adult safeguarding in England. It also offers insight into politicians’ views on what is known/unknown about the prevalence and circumstances of the problems with gaining access to adults with capacity where there are safeguarding concerns and politicians’ views on the merits or hazards of a power of access.

Accusations of misconduct among staff working with vulnerable adults in England and Wales: their claims of mitigation to the barring authority

The vetting and barring scheme known as the POVA (Protection of Vulnerable Adults) List established in England and Wales by the Care Standards Act (2000) was intended to provide greater assurance about the quality of social care for adults. This article reports on part of a larger research study investigating the Protection of Vulnerable Adults (POVA) List. It focuses on different kinds of mitigation used by staff to counter allegations of harming vulnerable adults and how these differ in relation to various types of abuse as well as other factors. The results are based on quantitative analyses of a detailed sample of 298 referral records of the POVA List and qualitative interviews with civil servants administering the POVA scheme. Details of the mitigation claimed by 135 workers are examined and these elements are described in relation to mitigation for the person and mitigation of the misconduct. Messages from the analysis are discussed in relation to the workforce, employers and adult safeguarding systems.

Social workers' power of entry in adult safeguarding concerns: Debates over autonomy, privacy and protection

The purpose of this paper is to explore debates about the powers social workers may need to undertake safeguarding enquiries where access to the adult is denied.,The paper takes as a starting point a scoping review of the literature undertaken as part of a study exploring social work responses to situations where they are prevented from speaking to an adult at risk by a third party.,A power of entry might be one solution to situations where social workers are prevented from accessing an adult at risk. The paper focuses on the Scottish approach to legal powers in adult safeguarding, established by the Adult Support and Protection Act (Scotland) 2007 and draws out messages for adult safeguarding in England and elsewhere. The literature review identified that debates over the Scottish approach are underpinned by differing conceptualisations of vulnerability, autonomy and privacy, and the paper relates these conceptualisations to different theoretical stances.,The paper concludes that the literature suggests that a more socially mediated rather than an essentialist understanding of the concepts of vulnerability, autonomy and privacy allows for more nuanced approaches to social work practice in respect of using powers of entry and intervention with adults at risk who have capacity to make decisions.,This paper provides a novel perspective on debates over how to overcome challenges to accessing adults at risk in adult safeguarding through an exploration of understandings of vulnerability, privacy and autonomy.

Pressure points: learning from Serious Case Reviews of failures of care and pressure ulcer problems in care homes

Serious Case Reviews (SCRs, now Safeguarding Adults Reviews (SARs)) may be held at local level in England when a vulnerable adult dies or is harmed, and abuse or neglect is suspected, and there is cause for concern about multi-agency safeguarding practice. There has been no analysis of SCRs focussing on pressure ulcers. The purpose of this paper is to present findings from a documentary analysis of SCRs/SARs to investigate what recommendations are made about pressure ulcer prevention and treatment in a care home setting in the context of safeguarding. This analysis is presented in cognisance of the prevalence and risks of pressure ulcers among care home residents; and debates about the interface of care quality and safeguarding systems.,Identification of SCRs and SARs from England where the person who died or who was harmed had a pressure ulcer or its synonym. Narrative and textual analysis of documents summarising the reports was used to explore the Reviews’ observations and recommendations. The main themes were identified.,The authors located 18 relevant SCRs and 1 SAR covering pressure ulcer care in a care home setting. Most of these inquiries into practice, service communications and the events leading up to the death or harm of care home residents with pressure ulcers observed that there were failings in the care home, but also in the wider health and care systems. Overall, the reports reveal specific failings in multi-agency communication and in quality of care. Pressure ulcers featured in several SCRs, but it is problems and inadequacies with care and treatment that moved them to the safeguarding arena. The value of examining pressure ulcers as a key line of inquiry is that they are “visible” in the system, with consensus about what they are, how to measure them and what constitutes optimal care and treatment. In the new Care Act 2014 context they may continue to feature in safeguarding enquiries and investigations as they may be possible symptoms of system failures.,Reviews vary in content, structure and accessibility making it hard to compare their approach, findings and recommendations. There are risks in drawing too many conclusions from the corpus of Reviews since these are not published in full and contexts have subsequently changed. However, this is the first analysis of these documents to take pressure ulcers as the focus and it offers valuable insights into care home practices amid other systems and professional activity.,This analysis highlights that it is not inevitably poor quality care in a care home that gives rise to pressure ulcers among residents. Several SCRs note problems in wider communications with healthcare providers and their engagement. Nonetheless, poor care quality and negligence were reported in some cases. Various policies have commented on the potential overlap between the raising of concerns about poor quality care and about safeguarding. These were highlighted prior to the Care Act 2014 although current policy views problems with pressure ulcers more as care quality and clinical concerns.,The value of this documentary analysis is that it rests on real case examples and scrutiny at local level. Future research could consider the findings of SARs, similar documents from the rest of the UK, and international perspectives.,The value of having a set of documents about adult safeguarding is that they lend themselves to analysis and comparison. This first analysis to focus on pressure ulcers addresses wider considerations related to safeguarding policy and practice.