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Purpose: Most abuse affecting older adults in the UK, as across Europe, takes place within caring relationships, where one person is disabled and needs care/support. This paper critically appraises two of the key theoretical explanations. First, feminist theories of "intimate partner abuse" tell us that it is mostly men who perpetrate abuse against women. Second, "carer strain": the stress caused by caring responsibilities, often with inadequate help from services. Neither fully reflects the complex dynamics of "dangerous care" leading to a lack of voice and choice in safeguarding responses. This paper aims to articulate the need for an overarching theoretical framework, informed by a deeper understanding of the intersectional risk factors that create and compound the diverse experiences of harm by disabled people and family carers over the life course. Design/methodology/approach: The critical synthesis of the theoretical approaches informing UK policy and practice presented here arises from a structured literature review and discussions held with three relevant third sector agencies during the development of a research proposal. Findings: No single theory fully explains dangerous care and there are significant gaps in policy, resources and practice across service sectors, highlighting the need for joint training, intersectional working and research across service sectors. Originality/value: Drawing both on existing literature and on discussions across contrasting policy and practice sectors, this paper raises awareness of some less well-acknowledged complexities of abuse and responses to abuse in later life. [ABSTRACT FROM AUTHOR]

This article discusses the Law Commission's proposals for the reform of adult social care, with a particular emphasis on the specific proposals relating to adult protection. It argues that a future adult social care statute should clarify the existing legal position by placing a duty on local social services authorities to make enquiries and take appropriate action in adult protection cases. The definition of an adult at risk for the purposes of the duty to investigate is also considered and a proposal is put forward for how this might be defined in the statute. The article also proposes that the compulsory removal power under section 47 of the National Assistance Act 1948 (HM Government, 1948) should be repealed, that adult safeguarding boards should be placed on a statutory footing and that duties to co-operate in adult protection should be introduced. Finally, concerns are raised that the current lack of statutory provision for adult protection may mean that there is confusion over the precise legal status of the guidance No Secrets (Department of Health & Home Office, 2000) and In Safe Hands (Welsh Assembly Government, 2000) and what actions this can authorise. [ABSTRACT FROM AUTHOR]

Purpose: Across the UK and Ireland, there are a range of processes and interventions offered to adults who, because of personal characteristics or life circumstances, require help to keep themselves safe from potential harm or abuse. The ways in which the statutory and voluntary sectors have chosen to safeguard these adults varies. Different models of intervention and the utilisation of a range of assessment tools, frameworks and approaches have evolved, often in response to policy and practice wisdom. Empirical research in this area is limited. The primary research purpose of the project on which this paper is based is to gather information on the range of tools and frameworks that are used in adult safeguarding practice across the UK and Ireland. In so doing, this paper seeks to contribute and inform the future development of an evidence based adult safeguarding assessment framework. Design/methodology/approach: A team of academics from England, Scotland, Northern Ireland and Ireland wanted to explore the possibility of adapting a pre-existing assessment framework currently in use in family and childcare social work to consider its utility in assessing carers involved in adult safeguarding referrals. This paper reports on a small pilot study which sought to inform the adaptation of this framework for use in adult safeguarding. This paper is based on a qualitative study involving 11 semi-structured telephone interviews with adult safeguarding social work managers and experienced practitioners. Two to four professionals from each region of England, Scotland, Northern Ireland and Ireland were interviewed to elicit their perceptions and experiences of engaging in adult safeguarding assessment processes and their views about models of assessment. Findings: This study identified considerable variation in and between the nations under review, in terms of the assessment frameworks and tools used in adult safeguarding practice. To a large extent, the assessment frameworks and tools in use were not evidence based or accredited. Participants acknowledged the value of using assessment frameworks and tools whilst also identifying barriers in undertaking effective assessments. Originality/value: There is limited evidence available in the literature regarding the utility of assessment frameworks and tools in adult safeguarding practice. This primary research identifies four themes derived from professional's experiences of using such frameworks and identifies broader recommendations for policy and practice in this area. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to highlight the issue of carers as victims and perpetrators of domestic abuse. The issue of carers as victims, and sometimes perpetrators, of domestic abuse is being overlooked by statutory organisations because they often do not fit the traditional patterns of abusive relationships, and the complexities of the caring role can make typical safety options unsuitable. However, caring responsibilities are a feature of an increasing number of domestic homicide reviews, and current statutory safeguarding options exclude most carers from support and risk not identifying perpetrators. Design/methodology/approach: This short paper highlights some of the shortfalls around identifying the needs of carer victims/survivors of domestic abuse and carer-perpetrators of domestic abuse and explores ways in which identification and support could be improved. Findings: Carers as victims/survivors of domestic abuse, and as abusers, is an issue that requires more attention from researchers and Adult Social Care, NHS, Carer Support Organisations and Domestic Abuse specialists need to work together to explore these issues and offer workable options. Originality/value: Little data or research exists around carers as victims or perpetrators of domestic abuse. [ABSTRACT FROM AUTHOR]

Purpose: The first purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SAR) and accompanying thematic analysis. A second purpose is to rebalance the narrative about adult safeguarding and self-neglect by highlighting two case studies where the practice was informed by SAR and the evidence-base of best practice. Design/methodology/approach: Further published reviews are added to the core data set, drawn from the websites of Safeguarding Adults Boards (SAB). Thematic analysis is updated using the four domains used previously. Two case studies are presented, using the four domains of direct practice, team around the person, organisational support and governance, to demonstrate that positive outcomes can be achieved when practice and support for practitioners align with the evidence-base. Findings: Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. The case studies are illustrative examples of what can be achieved and signpost SABs and SAR authors to question what enables and what obstructs best practice. Research limitations/implications: A national database of reviews completed by SABs has been established (https://nationalnetwork.org.uk) with the expectation that, in time, this will become a comprehensive resource. It is possible, however, that this data set is incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Although individual reviews might comment on good practice alongside shortfalls, no published SARs have been found that were commissioned specifically to learn lessons from what had worked out well. More emphasis could be given to what might be learned from such cases. Practical implications: Answering the question "why" remains a significant challenge for SAR not only where concerns about how agencies worked together prompted review but also where positive outcomes have been achieved. The findings confirm the relevance of the evidence-base for effective practice, but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of case studies with positive outcomes might enable learning about what enables positive system change. Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence base for practice. The paper presents two case studies where practice and the context within which practitioners were working closely aligned to the evidence-base for best practice. The paper suggests that SABs and SAR authors should focus explicitly on what enables and what obstructs the realisation of best practices. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to review safeguarding adult reviews (SARs) pertaining to individuals with acquired brain injury (ABI) since 2014. This extended literature review also explores the lessons and recommendations from these reviews in relation to social work practice within the UK. Design/methodology/approach: The literature review reported and discussed findings across reviews and then used a thematic analysis to synthesise the findings and recommendations from the SARs reviews. Findings: This paper identified four main themes: a lack of awareness of the needs of those with ABI and their families and around the symptoms and nuances of brain injury, particularly executive impairment and mental capacity, among social workers; poor interdisciplinarity led to a lack of shared communication and decision-making with professionals with such knowledge; a poor understanding of aspects of the mental capacity legislation, particularly surrounding unwise decisions, led to inappropriate or absent mental capacity assessments; and a lack of professional curiosity led to a lack of action where intervention or assessment was required. Research limitations/implications: This review identifies significant shortcomings in social work practice, education and training within the UK with regards to ABI. Practical implications: This paper provides recommendations to current social work practice and highlights the need for significant improvements in pre-qualification and post-qualification training and supervision of social workers. Originality/value: To the best of the authors' knowledge, while there have been extensive reviews conducted on SARs, this is the only review that has focused solely on ABI. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to draw together what is known regarding the characteristics and context of adult family violence, and to consider what practitioners and organisations in the UK might learn from the literature. Design/methodology/approach: This study reviews literature on adult family violence and parricide and includes illustrative cases from a study of domestic homicide review reports involving older adults. Findings: Adult family violence most often involves mothers killed by their adult sons. Mental health issues, alcohol/substance misuse and criminality are common themes for perpetrators. Caregiving responsibilities is a theme for both victims and perpetrators. Previous research identified two main categories of adult family homicide: perpetrators with major psychotic illness, and victims-perpetrators in complex relational contexts. Practical implications: This study considers how practitioners respond to situations of adult family violence and learning for policymakers, agencies and practitioners. Originality/value: This paper summarises what is known, argues that more research is needed and suggests practical ways forward for policymakers, relevant agencies and practitioners. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present an examination of the development of adult safeguarding policy from the perspectives of both policymakers and those who have sought to influence policy, to empower individuals with a learning disability to have a say in how policies, that influence their life and impact their right to independence, are developed. Design/methodology/approach: This paper is based on a project which was led by a UK-wide interdisciplinary and multi-agency team, which included the central involvement of peer researchers who had lived experience of learning disability. It was based on a participatory disability research design. Findings: Factors which enabled or restrained individuals with a learning disability, and their supporting organisations, from getting their voice heard in policy development, are identified. Originality/value: This paper builds on policy theory and research, making recommendations for policy makers, disabled people and their supporting organisations as to how adult safeguarding policy, could be more effectively informed and influenced. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present the case for examining the concept of positive risk taking (PRT) in the context of adult protection. The paper argues there is a need for empirical research to understand the application of and attitudes to PRT to explore whether the concept has moved beyond a principle to make an identifiable difference to service users. Design/methodology/approach: By investigating evidence from policy, literature and professional opinion, this paper presents the ethical tensions for professional practice in adult protection between respecting a service user's freedom to make choices to enhance their independence while preserving safety for service users and society. This is considered in the context of risk in health and social care and the recent changes in society resulting from COVID-19. Findings: Inherent tensions are apparent in the evidence in health and social care between attitudes propounding safety first and those arguing for the benefits of risk taking. This indicates not only a need for a paradigm shift in attitudes but also a research agenda that promotes empirical studies of the implications of PRT from service user and professional perspectives. Originality/value: This paper draws attention to the relatively limited research into both professionals' and service user's perspectives and experiences of PRT in practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases. Design/methodology/approach: Further published reviews are added to the core data set, mainly drawn from the websites of safeguarding adults boards (SABs). Thematic analysis is updated using the domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously. Findings: Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations. Research limitations/implications: The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications: Answering the question "why" remains a significant challenge for SARs. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the "why" question. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated. Originality/value: The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to stimulate discussion on how best to protect individuals from undue influence when gifting to religious institutions in England and Wales. Design/methodology/approach: This paper is based on the law relating to undue influence in England and Wales and draws from the literature regarding gifting to religious institutions and accountability of such institutions. Findings: This paper identifies that more needs to be done to protect individuals, so as to ensure they are gifting to religious institutions using their own free will. It highlights that although the law attempts to define undue influence, there is little guidance on where the line between persuasion and coercion lies. The paper recognises that religious institutions need to do more to adopt safeguarding policies and that the Charity Commission ought to better support such policies by creating a single point of reference. Practical implications: Steps need to be taken to prepare a cohesive set of principles that religious institutions of all denominations can follow to ensure they protect themselves from being accused of undue influence, as well as safeguarding individuals from abuse. Originality/value: There are limited studies that consider the dichotomy between religious gifting and undue influence. This paper adds to the existing discussion and considers ways in which individuals can be protected. The author is not aware of such considerations being directly contemplated as resolutions to this issue. [ABSTRACT FROM AUTHOR]

Purpose: This exploratory paper aims to examine the literature on the impact of COVID-19 on safeguarding adults practice. Design/methodology/approach: A literature search was carried out in recently published articles to locate literature relating to COVID-19 and safeguarding adults in the UK and internationally. This included policy guidance and law, to describe the existing knowledge base, gaps in practice and areas that may require further research. Findings: The findings suggest that measures to curb the spread of the COVID-19 pandemic gave rise to remote working and virtual safeguarding practice. The findings highlight the need for empirical research into the impact of virtual safeguarding adults assessments and effective ways to support the needs and outcomes of those who may be at risk of or experiencing abuse and neglect while shielding, socially isolating or when working in an environment where social distancing is required. Research limitations/implications: The paper is based on a review and analysis of published documents and not on other types of research. Originality/value: Little is known about effective safeguarding adults practice in the era of shielding, self-isolation, social distancing and remote working. The paper adds to the body of knowledge in the field. [ABSTRACT FROM AUTHOR]

Purpose: People with an intellectual disability are much more likely to be sexually violated and the violation is less likely to be reported. Despite this being high-lighted at least 3 decades ago and improvements in both safeguarding and national reporting processes, under-reporting remains a problem. This paper explored under-reporting alongside prevention possibilities using safeguarding alerts raised in a Community Learning Disability Team within a UK NHS trust. Design/methodology/approach: Using a combination of authentic but anonymised case vignettes and descriptive data drawn from the safeguarding team, under-reporting was examined through the lens of an ecological model. Safeguarding alerts raised in a particular year were compared with the number expected if all (estimated) cases of abuse were disclosed and reported. Findings: Only 4.4 per cent of expected abuse cases were reported to the team, which is lower than the reporting level the authors had expected from the literature. There is evidence in the literature of the under-reporting of sexual assault for all kinds of people. Arguably, the implications of under-reporting for PwID are even more traumatic. Research limitations/implications: Constraints included the lack of standardisation in data collection within the statutory services that report to the Birmingham Safeguarding Adults Board. One key recommendation is that the national provider of data for the NHS in the UK requires more complex and standardised audit information that would allow each local authority to benchmark their practice against a higher protection standard. Another recommendation is that compliance to quality standards sits within a comprehensive strategy. Originality/value: This paper explored the extent to which the previously documented under-reporting concern remains an issue. Certainly eye-balling safeguarding compliance data in the NHS organisation we worked in led us to a concern that reporting might be even lower than implied in the literature. This together with a renewed spot-light on sexual violence (e.g, NHS England, 2018) led us to decide that it was timely to re-examine the problem. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to present findings from face-to-face interviews with three former care staff who were proven to have abused some of the older people living in the care and nursing homes in which they had once worked. The research sought to explore the intra-personal dynamics, personal characteristics and work experiences that led these staff to perpetrate abuse. Design/methodology/approach: Semi-structured interviews were undertaken with three former care and nursing home staff who had committed abusive acts and the data secured subjected to thematic narrative analysis. Findings: None of the three people interviewed had intended to become care staff and reported that the interview and induction processes they experienced did little to establish their suitability for the work they would be undertaking or to prepare them for its demands. Participants expressed their generally negative perceptions of older people, particularly those living with dementia, and told of how they also felt that they were under pressure to conform with the often abusive care home regimes that they had entered. They also recounted some specific abusive practices developed to allow them to manage the constant tension between the time available to complete all of the tasks required when "caring" for older people, and revealed their perceptions of external scrutiny of care home conduct and the behaviours developed to deflect the effectiveness of this oversight. Two interview participants also revealed their unfavourable attitudes to some of the people they were employed to care for that were based upon perceptions of ethnic differences, and of how this had contributed to the abuse they perpetrated. Research limitations/implications: Though the research draws upon the experiences of only three former care staff, the data reveal some of the intra-personal dimensions of individual staff who have engaged in abusive acts, and illuminates how the care home environment with which they interact can engender conditions under which abuse is more likely to occur. Originality/value: Unusually, the paper explores the characteristics, perceptions and experiences of care staff who have actually committed abusive acts against those entrusted to their care. [ABSTRACT FROM AUTHOR]

Purpose In most European countries there is a range of quality control system mechanisms, however, poor quality and institutional violence can be found in the residential sector. Taking Portugal as an example of a country that uses an inspection-only approach, this paper focuses on the monitoring system for controlling the quality of care in nursing homes. The purpose of this paper is to analyse how mistreatment of older people is identified and dealt with by the national social security services. In particular it looks at what the indicators are with which to assess poor quality care and mistreatment (how it is perceived and defined), which factors affect mistreatment of older people and intervention outputs (i.e. what are the sanctions to prevent and combat this).Design/methodology/approach An exploratory approach was based on a mixed method, using a database of 3,685 complaints reported to the social security inspection services. To understand the context of the complaints and the assessment of institutional violence, focus groups were carried out with inspectors from the National Inspection Service.Findings The focus groups identified severe situations of poor care, mistreatment of older people and loss of human rights and dignity. Some indicators were found in key areas of care and the factors associated with this were based on Kamavarapu's typology (2017): physical conditions of facilities; closed organisational models; difficult working conditions; and perceived concerns of residents. Monitoring and inspection systems are still based on minimum standards focusing on structural and process quality, devoting little attention to the human rights situation of older persons and clinical issues.Research limitations/implications The number of participants in the focus groups was limited in size but the uniqueness of this exploratory method draws a dark picture of non-licensed nursing homes in Portugal.Originality/value An exploratory analysis was useful to identify institutional violence and discuss potential implications, in terms of effectiveness of quality care control, which calls for special attention by policy makers and researchers when monitoring the human rights of older persons. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to report the findings of a scoping study that explored the extent of recorded sexual violence perpetrated on inpatients on mental health (MH) units.Design/methodology/approach A Freedom of Information Act (FOI) request was sent to 45 police forces. The FOI asked for the number of recorded offences of rape and sexual assault by penetration for the five years 2010-2015. Following the responses from the police, a similar FOI request was sent to MH trusts.Findings There were significant variations in the way that both police forces and MH trusts approached the recording of this information.Research limitations/implications The research highlights variation and inadequacy of current recording practices in relation to sexual offences committed against inpatients on MH units.Practical implications There needs to be more consistent systems of recording of allegations of sexual assault and responses to them by agencies. In the trust recording of these incidents, it is recommended that a specific category of sexual violence is created. On a national level, the Office for National Statistics should produce a national data set that records the number of rapes that are committed in MH inpatient units.Originality/value This paper highlights the “gap” of information in relation to recorded rape and may indicate that complainants with a history of mental illness are less likely to have their allegation recorded as a crime. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to explore and critique the conceptual and terminological shift – particularly from “vulnerability” to “adult at risk” – in adult safeguarding under the Care Act 2014 and the Social Services and Well-being (Wales) Act 2014.Design/methodology/approach The paper compares the notion of the vulnerable adult in safeguarding, with the notion of an adult at risk under the Care Act 2014 and the Social Services and Well-being (Wales) Act 2014 and questions to what extent such a shift addresses existing criticisms of “vulnerability”.Findings The paper criticises the notion of the “vulnerable adult” for perpetuating the stigma associated with an impairment or disability, and for the types of legal and policy responses deemed appropriate under such an understanding of vulnerability. While efforts to replace the term “vulnerable adult” with “adult at risk” are, to some extent, to be welcomed, “adult at risk” under the legislation relies on the same characteristics for which the “vulnerable adult” has been criticised. Nevertheless, the safeguarding provisions under the two Acts have made some strides forward in comparison to their legal and policy predecessors and the notion of the “vulnerable adult”.Originality/value This paper’s originality and value lie in its scrutiny of the notion of “vulnerability” in adult safeguarding, in comparison to the newer terminology of an “adult at risk”, whilst also suggesting that in important respects – in relation to the interventions deemed appropriate where an adult is perceived to be at risk – the two pieces of legislation are a marked improvement on their predecessors. It also offers some thoughts as to how criticisms of the new legislation may be overcome. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to consider the impact of mental capacity legislation when applied to parents with learning difficulties who lack capacity within childcare and family law proceedings in England and Wales.Design/methodology/approach The paper relies on a range of material including reports published by independent mental health foundations, official inquiries and other public bodies. It also refers to academic and practitioner material in journals and government guidance.Findings The paper critically reviews the application of the guidance when assessing mental capacity legislation as applied in England and Wales and offers by way of illustration several case examples where psychological assessments, and the enhancement of capacity, have assisted parents who were involved in childcare and family law proceedings.Research limitations/implications There has been little published research or governmental reports on the number of cases when parents involved in childcare and family law proceedings have been found to lack capacity. No published prevalence data are available on the times when enhancing capacity has resulted in a change of outcome in childcare and family law proceedings.Practical implications The duty is on the mental health practitioners assessing mental capacity that they do so in a structured and supportive role adhering to good practice guidance and follow the guiding principles of mental capacity legislation assuming that the individual has capacity unless it is established that they lack capacity. Guidance and training is needed to ensure that the interpretation of the Mental Capacity Act (MCA) and its application is applied consistently.Social implications For those who are considered to lack mental capacity to make specific decisions, particularly within childcare and family law proceedings, safeguards are in place to better support such individuals and enhance their capacity in order that they can participate more fully in proceedings.Originality/value While the MCA legislation has now been enacted for over ten years, there is very little analysis of the implications of capacity assessments on parents involved in childcare and family law proceedings. This paper presents an overview and, in places, a critical analysis of the new safeguarding duties of mental health practitioners when assessing for, and enhancing capacity in parents. [ABSTRACT FROM AUTHOR]

Purpose Opportunities to gamble have boomed in the UK in recent years, since the passing of the Gambling Act 2005. The implications of this for adults with care and support needs and for safeguarding services have not been greatly investigated. The purpose of this paper is to address the interface of how gambling affects adults with care and support needs in England and adult safeguarding.Design/methodology/approach This paper reports on the scoping review which focussed on adults with care and support needs and gambling-related harm. It also included literature on perpetrators who exploit adults with care and support needs to fund their own or others’ gambling. The overall aims of this scoping review were to explore what is known about gambling-related harm affecting adults with care and support needs, the gaps in the evidence base, and specifically to refine the interview questions for the wider study.Findings There is some evidence that adults with care and support needs experience or are at risk of gambling-related harm. There is, however, lack of data from safeguarding services about this affecting adults at risk and safeguarding practice and systems. A public health approach to gambling is advocated by some, as well as effective regulation and support for people who have problems with their own or others’ gambling.Originality/value Industry operators, practitioners, and policymakers are increasingly paying attention to gambling-related harm but there is a lack of focus on adults with care and support needs or implications for adult safeguarding. [ABSTRACT FROM AUTHOR]

Purpose: The prominence of the best interests principle in the Mental Capacity Act 2005 represented an important transition to a more resolutely patient-centred model regarding decision-making for incapable adults ("P"). This paper aims to examine the courts' consideration of P's values, wishes and beliefs in the context of medical treatment, reflect on whether this has resulted in a wide interpretation of the best interests standard and consider how this impacts clinical decision makers. Design/methodology/approach: A particular focus will be on case law from the Court of Protection of England and Wales and the Supreme Court of the UK. Cases have been selected for discussion on the basis of the significance of their judgements for the field, the range of issues they illustrate and the extent of commentary and attention they have received in the literature. They are presented as a narrative review and are non-exhaustive. Findings: With respect to values, wishes and beliefs, the best interests standard's interpretation in the courts has been widely varied. Opposing tensions and thematic conflicts have emerged from this case law and were analysed from the perspective of the clinical decision maker. Originality/value: This review illustrates the complexity and gravity of decisions of the clinical decision makers and the courts have considered in the context of best interests determinations for incapacitated adults undergoing medical treatment. Subsequent to the first such case before the Supreme Court of the UK, emerging case law trends relating to capacity legislation are considered. [ABSTRACT FROM AUTHOR]

Purpose The landscape of adult social care, and in particular of adult safeguarding, has shifted considerably over the last decade. Alongside policy changes in the responses to adult abuse, there have been shifts in professional and public understanding of what falls within the remit of this area of work. This results, arguably, in differing understandings of how adult safeguarding is constructed and understood. Given the increasing emphasis on multi-agency inter-professional collaboration, service user involvement and lay advocacy, it is important to consider and reflect on how both professionals and lay people understand this area of work. The paper aims to discuss these issues.Design/methodology/approach This study employed Augusto Boal’s model of Forum Theatre to explore how a variety of professional and lay groups understood, related to and engaged with how the Care Act 2014 defines and describes “adult safeguarding”.Findings Lay participants responded to the scenario in a variety of ways, upholding the construct validity of “adult safeguarding” and the authority of the social worker. Social care and health practitioners sought orderly, professionalised and sometimes ritualistic solutions to the “adult safeguarding” scenario presented, seeking carefully to structure and to manage lay involvement. Inter-professional collaboration was often problematic. The role of lay advocates was regarded ambiguously and ambivalently.Originality/value This paper offers a number of practice and research recommendations. Safeguarding practitioners could benefit from more effective and reflexive inter-professional collaboration. Both practitioners and service users could benefit from the more thoughtful deployment of the lay advocates encouraged within the Care Act 2014 and associated guidance. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present an analysis of media reactions to the BBC Television Panorama programme, Behind Closed Doors’ and to set this in the context of interviews with care staff about their reflections on publicity about poor practice in the care sector.Design/methodology/approach This paper reports on an analysis of media reactions to recent exposé of abuse in social care in England and data from an interview-based study of care workers. The interviews were analysed to consider the impact of such media reports on staff and to explore their views of action that might be need to be taken about care failings.Findings There are mixed reactions to exposé of poor care on television and to the debates that precede and follow their broadcast. Debates occur in print and on television, but also in social media. The particular exposé of care home practices by the Panorama programme, Behind Closed Doors, led to debate in England about the potential role of covert cameras in care homes. The interviews revealed that while care staff are affected by scandals in the media about social care, they do not necessarily focus on themes that the media stories subsequently highlight. Overall some are disenchanted while others have ideas of what needs to change to improve practice. Care staff consider that there remain problems in raising concerns about practices and some staff feel unable to stay in workplaces where they have made complaints.Research limitations/implications The care workers interviewed may not be representative of the sector and they may have wished to provide socially acceptable answers to the researchers. Practice was not observed.Practical implications Local Safeguarding Adult Boards may wish to develop a communications strategy to deal with requests for reactions to media reports locally and nationally. Safeguarding practitioners may wish to prepare for increased referrals following media coverage of poor care in their areas. They may later be able to use media reports to discuss any local differences of interpretation over matters such as prosecutions for abuse. Trainers and educationalists may wish to clarify the importance given by care providers to raising concerns, the ways in which difficult conversations can be held, and the protections available to whistle-blowers or those raising concerns – with local examples to provide assurance that this is not mere rhetoric.Originality/value Television reports of problems with social care attract wide media interest but the authors know very little about how care workers respond to depictions of their work and their occupational grouping. This paper links media and expert commentator reactions to television exposé with data acquired from interviews with those on the frontline of care. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to present findings from a research project which investigated the approaches of different groups of assessors to the mental capacity assessments which are required to be conducted as part of Deprivation of Liberty Safeguards (DOLS).Design/methodology/approach Four case study vignettes were given to participants. Three groups involved in the DOLS assessment process were interviewed by telephone about the factors that may influence their capacity assessments.Findings Most assessors did not refer to the required two-stage test of capacity or the "causative nexus" which requires that assessors must make clear that it is the identified "diagnostic" element which is leading to the inability to meet the "functional" requirements of the capacity test. The normative element of capacity assessments is acknowledged by a number of assessors who suggest that judging a person's ability to "weigh" information, in particular, is a subjective and value-based exercise, which is given pseudo objectivity by the language of the Mental Capacity Act (MCA). A number of elements of good practice were also identified.Research limitations/implications In this exploratory study, participant numbers were small (n=21), and the authors relied on self-report rather than actual observations of practice or audit of completed assessments.Practical implications The findings are of relevance to all of those working in health and social care who undertake assessments of mental capacity, and will be helpful to all of those tasked with designing and delivering training in relation to the MCA 2005. They also have relevance to policy makers in the UK who are involved with reforms to DOLS regulations, and to those in other countries which have legislation similar to the MCA.Originality/value Much existing literature exhorts further training around the MCA. The authors suggest that an equally important task is for practitioners to understand and be explicit about the normative elements of the process, and the place of ethics and values alongside the more cognitive and procedural aspects of capacity assessments. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine and explicate the concept of poor care by exploring what it is and what contributes to its occurrence in practice with a particular focus on the care of older people.Design/methodology/approach The results of systematically searched published literature were analysed using an inductive, descriptive, thematic approach as part of Rodgers' evolutionary concept analysis method.Findings The concept of poor care is understood in the context of the antecedents of vulnerability, use of healthcare services and interaction with healthcare personnel. Its defining characteristics involve individual's personal traits, interpersonal dynamics, an endangered self, misconceptions or organisational constraints.Research limitations/implications Further research is needed to explore the recognition of poor care and reporting thresholds. In addition, the role of the "zone of tolerance" of expectations in the delivery and receipt of interpersonal care and attention for older people needs to be better understood.Originality/value Understanding the continuum and mapping the structures of poor care in contemporary UK healthcare practice can help sensitise practitioners to the widespread range and potential for instances of poor care. This concept analysis uniquely demonstrates consequences not only for the patient but also for healthcare staff and other individuals. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to explore the similarities and differences of legal responses to older adults who may be at risk of harm or abuse in the UK, Ireland, Australia and the USA. Design/methodology/approach – The authors draw upon a review of elder abuse and adult protection undertaken on behalf of the commissioner for older people in Northern Ireland. This paper focusses on the desk top mapping of the different legal approaches and draws upon wider literature to frame the discussion of the relative strengths and weaknesses of the different legal responses. Findings – Arguments exist both for and against each legal approach. Differences in defining the scope and powers of adult protection legislation in the UK and internationally are highlighted. Research limitations/implications – This review was undertaken in late 2013; while the authors have updated the mapping to take account of subsequent changes, some statutory guidance is not yet available. While the expertise of a group of experienced professionals in the field of adult safeguarding was utilized, it was not feasible to employ a formal survey or consensus model. Practical implications – Some countries have already introduced APL and others are considering doing so. The potential advantages and challenges of introducing APL are highlighted. Social implications – The introduction of legislation may give professionals increased powers to prevent and reduce abuse of adults, but this would also change the dynamic of relationships within families and between families and professionals. Originality/value – This paper provides an accessible discussion of APL across the UK and internationally which to date has been lacking from the literature. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report the findings from a study exploring the understanding of vulnerability and adult safeguarding within Christian faith-based settings. The paper concludes with recommendations for practitioners involved in safeguarding adults in faith-based Christian settings. Design/methodology/approach – The paper considers a survey (n=3,182) into understanding of vulnerability and adult safeguarding for individuals who attend Church regularly or work in a Christian organisation Findings – This study is the first to be undertaken with a UK sample and highlights a range of factors informing adult safeguarding practice within Christian organisations. This includes: complexity linked to understanding vulnerability and its role in safeguarding activity; lack of clarity about what to do with a safeguarding adult concern; and the need for safeguarding training pertinent to the particular needs of faith-based settings. Research limitations/implications – As there is currently a dearth of research in this area this paper makes a valuable contribution to the developing knowledge base around safeguarding and vulnerability within faith-based organisations. Practical implications – Professionals need to develop increased understanding of the complexities involved in safeguarding activity, and specifically how those working in the wider context of supporting vulnerable adults make sense of safeguarding processes and procedures. Social implications – It is important that all organisations, including faith-based settings, working with adults have an understanding of their roles and responsibilities with respect to safeguarding those at risk of harm. Originality/value – This paper is the first UK study to consider safeguarding adults at risk of harm in Christian faith contexts. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report and discuss the findings of a thematic analysis from a survey of 114 serious case review (SCR) executive summaries in adult safeguarding. The Care Act 2014 (Section 44) makes the establishment of Safeguarding Adults Boards a statutory requirement. One of their responsibilities/functions is to undertake Safeguarding Adults Reviews (SAR-previously known as SCRs). They must also publish an annual report which includes the recommendations and actions from these SAR’s. This paper draws attention to the potential of SCR as national learning materials, and offers recommendations for strengthening the scope for interpretation in practice. Design/methodology/approach – This paper maps the findings and recommendations from 114 SCRs undertaken in England and Wales between 2000 and 2012. It then identifies the dominant themes and universal lessons to emerge, and makes suggestions for the improvement of learning. Findings – The demographic profile of SCRs bore some correlation to UK prevalence reports on perpetrator characteristics, but there was variance in relation to victim characteristics, where people with mental illness were the subject of SCRs with a level of frequency that does not mirror the prevalence of mental illness in reported abuse in the UK. The thematic analysis of conclusions and recommendations identified that these could be categorised as either idiosyncratic or bureaucratic. Research limitations/implications – The quality and quantity of information contained within the various SCR executive summary reports collated evidenced the lack of consistency/standardisation. Consequently, the analysis of demographic characteristics from these reports was compromised by incomplete data. In order to strengthen the scope of interpretation and understanding from future SARs to inform wider learning within the safeguarding community some national collation and standardisation is necessary. Originality/value – This paper offers an analysis of the demographic profile and common themes emerging from an examination of the largest survey of SCR executive summaries reported on in the UK so far. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to outline how questions relating to capacity arise in the context of safeguarding, and when applications to the Court of Protection are required in relation to those who may lack capacity. It also seeks to provide guidance as to how applications to the Court of Protection should be made so as to ensure that they are determined effectively and in a proportionate fashion. Design/methodology/approach – The paper draws on the practical experience of practising barristers appearing before the Court of Protection, and on the experience of a social worker who is an MCA/DOLS lead at a London local authority. The paper proceeds by way of a review of the relevant statutory provisions, an overview of the Court of Protection and then to a practical analysis of when and how applications to the Court need to be made. Findings – When to go to the Court of Protection in the safeguarding context is poorly understood, and there has not been proper recognition of the fact that proceedings for “adult care orders” have a strong forensic analogy with applications for care orders in relation to children. It is only by recognising these forensic similarities that local authorities can properly make use of the Court of Protection in the discharge of their obligations to vulnerable adults in their area. Practical implications – The paper should lead to a recognition that there is a specialist “adult protection court” within the Court of Protection, and that applications for adult care orders to that court require specific and careful preparation and presentation. It will therefore lead to better use of the Court of Protection in the safeguarding context and – ultimately – a better balance between empowerment and protection of vulnerable adults who may lack capacity. Originality/value – The paper is original in combining both legal and social work expertise to reach practical conclusions as to why such poor use has been made of the Court of Protection in safeguarding context. Its value lies in the deployment of that expertise to suggest how better use can be made in the future. [ABSTRACT FROM AUTHOR]

Purpose – All nursing students have the opportunity to gain experience in the Independent Sector. The Health and Social Care Act (2012) in the UK has led to more health services being provided by the Independent Sector. The purpose of this paper is to explore the perceptions of first year student nurses of their learning experience in nursing homes placements within the Independent Sector. Design/methodology/approach – Two focus groups were undertaken with first year student nurses, one with six students and the other with seven students. All students had completed four week clinical placements in nursing homes. The focus groups were semi structured. Thematic analysis was undertaken on the data. Findings – Important themes that emerged from the data included: leadership issues, poor practice relating to infection control and manual handling, team dynamics, commitment to addressing issues when raised and challenges to raising issues within the placement area. The findings provided an insight into some of the barriers for student nurses when raising issues. The decision to raise concerns was multifactorial and complex. Attention was also focused on the relationship between the mentor and the student and the impact that can have on the learning environment. Research limitations/implications – The limitations for this study included: this was a small scale study, the findings were from a small number of placement areas within a small geographical area of the UK. Some students may have felt reluctant to share their views in a focus group. The findings reflect the views of first year student nurses only. However, first year students can provide an alternative view of a placement area. Their lack of experience can be an opportunity to question accepted norms with the mentor, acting as a resource of new ideas. Originality/value – This paper identified opportunities and challenges for student nurses and education providers alike. For the student it was the complexities of raising issues and for the education provider it was equipping students with the knowledge and skills to raise such issues not only as a student but also upon qualification. [ABSTRACT FROM AUTHOR]

Purpose – At a time when funding arrangements are under review, the purpose of this paper is to come to a better understanding of victim needs and to inform future developments of services in England and Wales. Design/methodology/approach – This paper is based on qualitative data gathered from a series of interviews with 33 individuals working with victims of crime in one police area in England and Wales. Findings – Better practice and outcomes were associated in respondent’s accounts with the multi-agency working and end to end case management of needs associated with some victims of rape and domestic abuse assessed as high risk of harm. Research limitations/implications – Small-scale qualitative study. Practical implications – It is argued Police and Crime Commissioners (PCCs) should explore mechanisms for extending such services to more victims of crime and ensuring better co-ordination of service delivery. Originality/value – From October 2014 onwards PCCs are set to take over responsibility for funding victim services in England and Wales. Though not an uncontroversial development, this sets the context for practice with victims to be considered afresh and accordingly this paper explores the needs of victims and how they are met in one police and crime area. [ABSTRACT FROM AUTHOR]

Purpose - The purpose of the paper is to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients. Health and social care policy frameworks promote principles of service improvement and consistency, along with a focus on outcomes and resource effectiveness and interagency collaboration. The Protection of Vulnerable Adults (POVA) coordinator role carries the responsibility of coordinating a response to individual referrals of abuse and neglect as described as part of the Designated Lead Manager role in the Wales Interim POVA Policy and Procedures for the POVA from abuse (Wales Adult Protection Coordinators Group, 2013). Design/methodology/approach - This paper will explore the benefits realised through a registered nurse being seconded from the Aneurin Bevan University Health Board into a newly created joint adult protection Health Coordinator post within the Caerphilly County Borough Council social services department POVA team. Findings - This is the first example of such partnership working in adult protection in Wales and has provided a number of benefits in relation to: providing adult protection advice; coordinating the response to referrals of vulnerable adult abuse and neglect within health and social care settings; carrying out or buddying others to complete adult protection investigations; facilitating the two day non-criminal POVA investigation training course and, awareness raising within the local Health Board. The development of a student nurse placement in the social services POVA team cements the multiagency collaborative approach that this development sought to achieve. Originality/value - The need to improve the consistency and quality of the response to vulnerable adults who experience abuse and neglect within NHS, independent healthcare and social care settings is noted by practitioners, agencies and patients. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to report the findings from research into 40 serious case reviews (SCRs) involving adults who self-neglect. Design/methodology/approach -- The study comprised analysis of 40 SCRs where self-neglect featured. The reviews were found through detailed searching of Local Safeguarding Adult Board (LSAB) web sites and through contacts with Board managers and independent chairs. A four layer analysis is presented of the characteristics of each case and SCR, of the recommendations and of the emerging themes. Learning for service improvement is presented thematically, focusing on the adult and their immediate context, the team around the adult, the organisations around the team and the Local Safeguarding Board around the organisations. Findings -- There is no one typical presentation of self-neglect; cases vary in terms of age, household composition, lack of self-care, lack of care of one's environment and/or refusal to engage. Recommendations foreground LSABs, adult social care and unspecified agencies, and focus on staff support, procedures and the components of best practice and effective SCRs. Reports emphasise the importance of a person-centred approach, within the context of ongoing assessment of mental capacity and risk, with agencies sharing information and working closely together, supported by management and supervision, and practising within detailed procedural guidance. Research limitations/implications -- There is no national database of SCRs commissioned by LSABs and currently there is no requirement to publish the outcomes of such inquiries. It may be that there are further SCRs, or other forms of inquiry, that have been commissioned by Boards but not publicised. This limits the learning that has been available for service improvement. Practical implications -- The paper identifies practice, management and organisational issues that should be considered when working with adults who self-neglect. These cases are often complex and stressful for those involved. The thematic analysis adds to the evidence-base of how best to approach engagement with adults who self-neglect and to engage the multi-agency network in assessing and managing risk and mental capacity. Originality/value -- The paper offers the first formal evaluation of SCRs that focus on adults who self-neglect. The analysis of the findings and the recommendations fromthe investigations into the 40 cases adds to the evidence-base for effective practice with adults who self-neglect. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to summarise the Law Commissions' final report and draft Bill on the regulation of health and social care professionals. Design/methodology/approach -- To summarise the key recommendations that are relevant to adult safeguarding. Findings -- The final report concludes that new legislation is needed to govern the UK regulators of health and social care professionals. Originality/value -- The paper sets out the recommended new legal framework. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to highlight the provision of therapy for witnesses who have a learning disability prior to and following a criminal trial. Authors will reflect on clinical practice whilst stressing that this area of work is in its infancy and both continue to learn through continued reflection and each new experience. Design/methodology/approach – The paper broadly describes the nature of pre-trial therapy followed by reflection by a Counsellor and Supervisor on their clinical practice. Findings – Authors describe some of the common themes that arise whilst providing pre-trial therapy. Social implications – The authors hope that the paper will encourage professionals involved in Safeguarding cases to fully consider the emotional needs of victims and to seek timely therapeutic support where the need presents. They also hope that it will encourage practitioners from various professions to consider providing this specialist and delicate type of therapy whilst highlighting the need for good supervision. Originality/value – There is a paucity of written information about this specific subject area. Although safeguarding of vulnerable adults has grown considerably over the last decade and investigations are now more likely to lead to legal action, the availability of emotional support for victims who have learning disabilities needs to be addressed. [ABSTRACT FROM AUTHOR]

Purpose – Domestic abuse continues to be largely hidden phenomenon. For older survivors this invisibility is further compounded by conceptual confusion surrounding domestic abuse and other forms of family violence. The purpose of this paper is to explore service responses to abuse among older people from across a range of sectors. Where possible the perspectives of older people themselves were explored. Design/methodology/approach – A mixed methods approach incorporating postal questionnaires and semi-structured telephone interviews. Agencies and organizations from both the statutory and voluntary sector who provided specific domestic abuse support services or general services and support for older people (aged 59 years and over) and older people, either as survivors of abuse or with an interest in the development of services for older people within one region of the UK were invited to take part in the project. In total, 18 individuals from a range of agencies and three older women survivors agreed to take part in the study. Findings – The findings highlighted three main themes, first, lack of conceptual clarity between domestic abuse and elder abuse, second, complexity of family dynamics and abusive relationships, and third, deficit in dedicated service provision for older survivors. The findings are discussed within the context of the existing literature and key recommendations include wider recognition of the significance of inter-professional education, training and working practices. Originality/value – This paper identifies the complexities and challenges that continue to face organizations in terms of recognition and provision of services for older survivors of abuse. [ABSTRACT FROM AUTHOR]

Purpose A previous publication in this journal reported the findings of a 2013 survey into people’s experiences of membership of a Christian church in the UK (author citation removed for the purposes of review). A major finding of this survey was that many people said they had been “harmed” by their experience with some labelling it as “Spiritual Abuse” (SA). Respondents in the 2013 study also stressed the importance of developing safeguarding policy and practice in this area. The purpose of this paper is to explore the findings of a more extensive survey conducted in 2017 which aims to identify people’s understanding of SA some four years after the initial work and within a context of some discussion and uncertainty around the term itself. The study also aims to assess the current status of safeguarding policy and practice in SA perpetrated against individuals in the Christian church in the UK. A secondary aim of the study is to ascertain how far understandings, policy and practice have developed since the initial survey was conducted. It is emphasised that the authors do not assert that SA is perpetrated solely in the Christian church. However, as this is their personal religious background it is the focus of this work.Design/methodology/approach A mixed methods online survey of Christians, Church attendees and members of Christian organisations was conducted in 2017. Data were analysed using descriptive statistics, inductive thematic and content analysis.Findings A clear definition of SA is required. There is an ongoing need to develop policy and practice in the area of SA in order to respond effectively to those who have these harmful experiences.Research limitations/implications This work has been conducted within the Christian faith community and thus, represents only this faith context. Accordingly, it is research with a specific group. The work would usefully be expanded to other faith contexts.Practical implications People are still being harmed by experiences in the Christian church. Safeguarding policy and practice in the area of spiritual abuse needs to be developed in the immediate future.Social implications Those working in statutory agencies, faith and community contexts need to develop an understanding of SA.Originality/value This is the largest survey conducted on the topic of SA in the Christian faith to date in the UK. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report the findings of a ground-breaking survey into people's experiences of church and Spiritual Abuse (SA), in a context of issues of safeguarding and policy. Design/methodology/approach – The survey was delivered online between April 2011 and December 2012. Findings – The findings showed many people had encountered negative church experiences. Most respondents had very limited knowledge and understanding of SA and related support and intervention. Research limitations/implications – This survey represents the views of a small percentage of those who attend, or have attended, church and further more extensive research is required to provide a more comprehensive understanding. Additionally research is required within other faiths and cultural contexts. Practical implications – It is evident that there is clearly a need to strengthen current safeguarding policy and practice with regards to SA. Originality/value – This paper offers an initial insight into the challenges for safeguarding together with some suggested intervention strategies. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to report and analyse a recent case, in which the safeguarding procedure adopted by one local authority was criticised by the High Court. It also seeks to identify the key lessons to be learned. Design/methodology/approach – The paper considers the judgment handed down in the case, sets out its key points and seeks to place the proceedings, and the concerns they reveal, in their context. Findings – In its conduct of one safeguarding enquiry, West Sussex County Council acted unlawfully, in a manner that breached natural justice and a legitimate expectation to which it had itself given rise. The case raises a number of concerns. It is also consistent with a suspicion that some practitioners, and even some judges, have begun to express: that on occasions, the safeguarding process itself might constitute a form of abuse. Originality/value – This is believed to be the first time the case has been analysed in such detail, and also the first time it has been placed in the context of those concerns. [ABSTRACT FROM AUTHOR]

Purpose – This paper presents an overview of research and practice literature on the use of Mediation (M) and Family Group Conferences (FGC) in the context of adult safeguarding in the UK. Design/methodology/approach – This paper describes the main features of M and FGC and explores how such "family led" approaches to adult safeguarding fit within the wider agenda of personalisation and empowerment, including the Mental Capacity Act 2005 and its associated Code of Practice. It also considers the main implications for best practice and future research and service priorities. Findings – M and FGC in an adult context are inclusive processes that enable people to explore choices and options in a supportive environment, assuring maximum possible independence and autonomous control over basic life decisions, while still addressing the person's need for assistance. When used appropriately, both approaches can be a valuable response to safeguarding concerns, promoting choice and control at the same time as protecting people from risk of abuse and harm. However, there are few robust evaluation studies currently available and no systematic research studies were found on cost-effectiveness. Originality/value – The paper shows that there is a clear need for further pilots of M and FGC in adult safeguarding. If such research and pilot evaluations find M and/or FGC to be effective, then more consideration will need to be given as to how to integrate such approaches into mainstream social work practice. There is also currently wide variation in the training and experience of mediators and FGC co-ordinators, and further work is required to ensure that there are appropriate training and accreditation models in the UK for mediators and FGC co-ordinators working with at-risk adults. [ABSTRACT FROM AUTHOR]

Purpose – There have been increased concerns about disciplinary procedures in relation to adult safeguarding. The purpose of this paper is to argue that the personal "boundary attitude" of workers is a strong component of their response to issues that have a safeguarding dimension. Design/methodology/approach – This study reports an analysis of questionnaire responses and data generated from interactive training events. Findings – The data suggest most workers adopt a personal stance or "boundary attitude" that drives their response to many of the diverse circumstances they face at the interface of their professional and personal life. Research limitations/implications – The particular profession, stage in career development or work environment may affect staff responses and this needs further exploration. Practical implications – There are implications for how services identify the most effective workers and their least effective colleagues, as well as for staff selection and training. Improving our understanding of boundary attitude will help to protect vulnerable people from abuse whilst supporting them to have a full life. Social implications – A better understanding of whether staff who maintain rigid boundaries deliver better outcomes than their colleagues who exercise substantial flexibility will help in recruitment, supervision and safeguarding activities. Originality/value – The paper explores an under-recognised issue in adult safeguarding, the personal "boundary attitudes" of staff, and their impact on judgements that affect a range of professional decisions they take. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to set out and discuss findings from a developmental study, commissioned by the English Department of Health and the charity, Comic Relief, which was commissioned to clarify definitional issues and recommend ways of operationalising key concepts for a prospective survey of abuse, neglect and loss of dignity in the care of older people in residential care in the United Kingdom (UK). Design/methodology/approach – As well as drawing upon their experience and expertise, the authors conducted a review of the literature, held consultation events with a range of stakeholders and undertook in-depth interviews with international academics and care home residents. Findings – Existing definitions and descriptions vary widely in form and content, are commonly subjective and imprecise and frequently make reference to abstract concepts which themselves need defining. Many of the concepts are also inherently evaluative, unspecific and open to interpretation. The study considered how, in this context, practical research definitions that are clear, unambiguous and widely acceptable to a range of stakeholders could be developed. Research limitations/implications – The study took a UK focus and the review of literature was confined to the English language. Further research might usefully extend discussion about definitions cross-culturally. The interview samples were small and should not be considered to be representative. Originality/value – The paper identifies key issues in defining the perpetrator. It focuses on the concepts of trust and intentionality, the responsibilities of the care home and multiple perpetrators and makes practical proposals for operationalising the "perpetrator" in research. Recommendations from the study were positively received and have directly informed the Government-funded research programme in England. [ABSTRACT FROM AUTHOR]

Purpose The 2015 Modern Slavery Act focusses attention forms of modern slavery (human trafficking and forced labour), within the UK. The contemporaneous 2014 Care Act, identifies modern slavery as a new form of risk within adult social care, listing forms of abuse and vulnerability. However, it does not consider whether those providing care may themselves be vulnerable to forms of modern slavery. The paper aims to discuss these issues.Design/methodology/approach The authors describe the history of the development of modern slavery legislation in the UK, outline key provisions of the Care Act, illustrated with real-life cases. The analysis suggests that adult social care – characterised by informality, fragmentation and vulnerability – is one where instances of modern slavery may be more common than considered to date.Findings The data collected, though relatively modest, suggests that a thorough investigation should be undertaken into the possibility of modern slavery taking place within the realm of adult social care.Research limitations/implications Data have been collected through a snowball process, rolling out a survey to relevant groups of individual and organisations. A more rigorous investigation is required to examine the extent of modern slavery within adult social care.Practical implications The training of those responsible for the regulation/management of adult social care needs to ensure that they are fully equipped to understand the nature of modern slavery and how to identify its symptoms and victims.Social implications There is also a need for heightened awareness of those close to people being cared for that they may also identify the symptoms of modern slavery.Originality/value This area has not been explored to date. [ABSTRACT FROM AUTHOR]

Purpose – The Mental Capacity Act (MCA) was implemented in 2007 as a piece of legislation to empower and protect adults who require support making decisions. Many older adults in residential care homes will be in this position due to developmental disabilities associated with functional impairments of the mind and brain. This paper aims to evaluate the impact of MCA training within older persons' care homes within an East-Midlands local authority. Design/methodology/approach – Semi structured interviews were conducted with key informants who had strategic responsibility for implementation of MCA training as well as a focus group conducted with managers/deputy managers of care homes within the local authority. Findings – With a primary focus on training, data revealed issues surrounding the delivery and content of training, and the organisational factors relating to both training and the subsequent implementation of the knowledge learned. Research limitations/implications – The key informants for this paper are limited to management perspectives. Interviews and a focus group were conducted with stakeholders who either had direct responsibility for service delivery or managerial oversight for training and development. Practical implications – The paper suggests methods of delivery with the Mental Capacity Act which offer a tailored, engaging and cost effective alternative to conventional "away day" training sessions. Originality/value – The paper challenges and critiques conventional approaches to training the social care workforce. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to summarize the work of the Court of Protection. Design/methodology/approach – The paper outlines the history and range of applications within the jurisdiction of the Court, drawing from the Mental Capacity Act and the Code of Practice. Reference is made to annual reports of the work of the court which profile its workload. Finally there is a review of a line of case law dealing with the question of media attendance and reporting of cases before the court. Findings – The Court in its current form was established under The Mental Capacity Act, 2005 and is a significant decision-making body in the UK within adult safeguarding practice concerning adults whose decision-making capacity is impaired. The implications of several specific cases are discussed. Originality/value – This paper provides a unique insight into the work of the Court of Protection and the implications of recent decisions by the Court for adult safeguarding. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this paper is to set out the Law Commission's proposals for the reform of the law relating to UK health professional regulation and, in England only, social workers. Design/methodology/approach – The paper summarises the main provisional proposals from the consultation paper. Findings – The consultation paper argued for the reform of the law in this area. Practical implications – There are suggestions for reforming the law which could form the basis of a new legal framework introduced in 2014. Originality/value – The paper sets out the proposed new legal framework. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to develop understanding of the context in which the abuse and maltreatment of older people might proliferate within the health and social care system in the United Kingdom. Drawing on the notion of "social defences" this paper seeks to explore the dual role of consumerism and social defences in facilitating poor practice. Design/methodology/approach – Research and inquiry findings are used to establish the inter-relationship between social defences, consumerism and poor organisational structures to create a culture in which the abuse and maltreatment of older people might flourish. Findings – The paper suggests the expansion of a consumerist approach to care, along with social defences and organisational structures, reinforces an attitude of indifference to older people across society, and provides the conditions in which the maltreatment of older people by professional carers can go unchallenged. Research limitations/implications – This is a conceptual paper from which future research could develop to understand, from a societal perspective, the relationship between societal attitudes and responses to older people, their maltreatment and care provision in the UK. Practical implications – Reform is required at a structural and individual level founded on the conceptual nets of equality and human rights. A consumerist approach alone, for those most vulnerable, may increase their risk of harm. Social implications – If safeguarding older people is "everyone's" business, wider society will need to transform an attitude of indifference toward older people into one of dignity and respect. Originality/value – The current system of health and social care provision leaves many older people maltreated and without support. Whilst much research rightly focuses on practical matters this paper seeks to relocate the debate in a much wider frame of reference to try and establish the philosophical, ethical and moral framework's required to transform societal indifference toward older people to respect. [ABSTRACT FROM AUTHOR]

Purpose – This paper aims to explore the potential impact on families of a greater emphasis on safeguarding for vulnerable adults, from both a legal and a lay perspective. Design/methodology/approach – Case examples are used to illustrate some of the issues and problems that can arise in safeguarding situations. Findings – In community settings there can be a tendency for Social Services to take an antagonistic rather than a conciliatory approach when communicating with families. In the setting of a care home, an example of the appropriate use of safeguarding is outlined. Practical implications – The authors argue that Social Services should take a more conciliatory approach and be prepared to work in partnership with families. Originality/value – The discursive format and narrative approach of this paper represents a useful and informative way of presenting important and topical insights. [ABSTRACT FROM AUTHOR]

Purpose -- Little is known about the implications of employing agency staff on safeguarding or the reasons why employers recruit staff from agencies who specialise in supplying staff to the sector or why social care staff work for such agencies. This paper aims to present findings from a study of agency workers in social care services in England. Design/methodology/approach -- Drawing on a review of the literature and policy documents, the study involved a survey of local authorities and interviews were conducted with 93 agency workers and other stakeholders. The interviews took place in three selected localities and data were analysed thematically. The survey investigated local authorities' use of agency workers, enquiring about reasons for this means of employment and any trends. The survey findings were contextualised by national data from England. Findings -- Analysis of interview and survey data revealed a variety of reasons for the employment of agency staff. In relation to safeguarding, agency workers filled staffing gaps and met needs for social care services or assessment; however , their abilities to offer continuity of care and sometimes to work within existing systems were compromised. Some employers did not provide agency workers with access to professional development opportunities or supervision. Practical implications -- The findings are used to develop recommendations for safeguarding practice at local level. Originality/value -- There is a temptation to depict agency workers as presenting safeguarding risks: this paper argues that a more rounded picture should be offered and a systems approach adopted. [ABSTRACT FROM AUTHOR]

Purpose -- The purpose of this paper is to summarise findings of a review of service user and carer involvement in safeguarding and recommendations for good practice. Design/methodology/approach -- The study involved a review of selected literature and a consultation exercise with experts in the field of adult safeguarding and telephone interviews with 13 Adult Safeguarding Leads across England and Wales. Findings -- Service users value rights, independence, choice and support. Adult Safeguarding policy sets out an expectation of service user involvement in the process and expects agencies to balance rights to self-determination with properly managed risk. In practice, agencies tend to be risk-averse and service users often do not feel involved in their safeguarding processes. Processes such as collaborative risk enablement, training and capacity building, working with BME groups and evaluation of involvement help. Good practice examples of involvement in Safeguarding Boards or local forums, developing new methods of user feedback and community involvement were found. Recommendations include more involvement of service users in research, more effective forms of involvement of groups who may be more excluded, shared responsibility for risk, and more training in rights legislation. Practical implications -- The paper offers recommendations for good practice in improving involvement in adult safeguarding, which is a requirement and an essential component of delivering good services to vulnerable adults. Originality/value -- Service user involvement in health and social care is now widespread, but there is little knowledge of how to involve the most vulnerable service users who are in need of protection, or how to balance risk and empowerment. This paper addresses the dilemmas facing Adult Protection staff, summarises the experience of practitioners based on the first decade of adult safeguarding work and sets out guidance for improving practice. [ABSTRACT FROM AUTHOR]

Purpose -- This paper seeks to consider the Deprivation of Liberty Safeguards (DoLS) and, in particular, the extent to which the functions of supervisory bodies can, or should be, performed as part of wider "safeguarding" responsibilities. Design/methodology/approach -- The paper reports the views of practitioners, given in response to comments made by the Care Quality Commission. Findings -- Some practitioners believe that DoLS and safeguarding functions should be consolidated, and some, that they should remain discrete; most, however, accept that the two functions should work closely together, and also that an understanding of the Mental Capacity Act is important for each; there is a suspicion that DoLS-activity is greatest where the two functions are kept discrete (and, it is assumed, DoLS practitioners therefore have more to prove); there is also concern about financing, particularly within discrete DoLS services, and, furthermore, some suspicion about the whole business of "safeguarding"; the Neary case continues to cast a long shadow. Originality/value -- This is believed to be the first time practitioners' views have been sought or at least published on this question. [ABSTRACT FROM AUTHOR]