How to help when being hindered? Professional responses when

faced with third parties preventing access to adults at risk at home

Martin Stevens Stephen Martineau Caroline Norrie Jill Manthorpe

York Making Research Count York University 17/10/2017

Acknowledgement and Disclaimer

• This presentation presents independent research funded by the Department of Health

• The views expressed in this presentation are those of the authors and not necessarily those of the Department of Health

Introduction

• What is hindering?

• Helping or hindering research

• How big is the problem?

• Why are third parties obstructive

• Risks of obstructive behaviour

• Practice approaches

• Conclusion

What is hindering?

Where social workers or other professionals face difficulties in accessing an adult at risk because of the actions of a third party, in the course of carrying out a safeguarding enquiry

Forms of hindering

• Access to the premises is being denied by a third party, typically a family member, friend

• Access to the premises is gained, but it is not possible to speak to the adult alone – because the third party insists on being present

• The adult at risk themselves (whether or not unduly under the influence of the third party) is insisting that the third party be present

• If the person is known NOT to have capacity then MCA applies

Example

• A safeguarding referral requiring a visit to an older woman with mental health problems

• No answer, neighbours said the she had moved to a nursing home

• Housing officer said she was still registered at the address• Housing officer and social worker about to enter the

property (with the aid of a locksmith) in case of (possible) medical emergency

• An unknown male confronted them and they couldn’t get in

• The police agreed to gain access because of fears of a medical emergency

• The man was detained under the Mental Health Act• The woman moved to nursing home care

Helping or hindering in adult safeguarding: our investigation of practice

• Phase 1 – Literature review

– Secondary analysis of DH consultation on power of access and parliamentary debate (remember Care Bill?)

• Phase 2– Survey of adult safeguarding managers (n=27)

• Phase 3– In-depth study in three Local Authorities

– Interviews with safeguarding and social work managers (n=15), social workers (n=22) and older and disabled people (n=6) and carers (n=5)

How big is the problem?• None of the survey respondents or practitioner interviewees reported that

data were collected specifically in relation to obstruction by third parties. • Widely varying estimates of numbers of cases were reported ranging from

0 to 70. • In most of these cases access was achieved, although often compromised

by an inability to conduct a private interview.• Participants stressed the heavy demands placed on human resources from

cases where obstruction was long-lasting and serious, some of which ran for several years.

Why are third parties obstructive?

• Parents or other family members were being arguably over-protective (often in cases involving an adult at risk with learning disabilities).

• Some third parties were thought to be fearful that the social worker would disrupt an established relationship.

• The obstructive third party might have his or her own mental health or addiction problems.

• Third parties might also be anxious that their opinion will not be heard • in some cases they were concerned about their own tenancy or immigration

status. • Cultural factors might be in play – for example, the third party objecting to a

male social worker seeing a female adult at risk. • Hindering was not always associated with abuse, according to interviewees.

Risks of obstructive behaviour

• Poor care

• Abuse

• Risk management

• Hoarding

• Cuckooing

• Domestic violence

• Modern slavery

Practice approaches

• Multi-agency and multi-disciplinary collaboration required with– Health professionals– Housing officers – Social care workers/agencies– Police– Dept of Work and Pensions– Other services (e.g. gas engineers)– Other family members – Neighbours/former neighbours

• Support from colleagues and managers• Social Work negotiation skills

– Hard and Soft – Use of legal routes– Creativity– Well matched social worker

Practice approaches

• Legal, governance and guidance context

• Negotiation and relationship building

• Creativity

• Managing risk with social work colleagues

• Informal and formal multi-agency approaches and information sharing

Legal, governance and guidance context

• Making Safeguarding Personal

• Local safeguarding policies

• Legislation.

– Mental Capacity Act (2005)

– Human Rights

• Social Care Institute for Excellence (SCIE) guidance

Balance of structured approaches and professional skills

• Social workers reports decisions based on professional judgement and practice wisdom

– Fits with guidance highlighting decisions based on values, ethics, critical thinking and risk (British Association of Social Workers (BASW), 2016)

• Decisions about using use legal routes to gain access based on their previous poor experiences

– Knowledge

• Conflict between professional judgement and decision-making processes, in terms of professionals’ views?

Manager’s perspective

[My role is] advisory and guidance for decision-makers like team managers, district service managers. So it's mainly responsibility for making defensible decisions in safeguarding but also the governance about making decisions and the processes in place to investigate any cases across another organisation. (Manager 25)

Sensitive allocation of social workers

Because I've obviously been around for too long, I tend to get complex ones. […] I think it's all about the person's experience, and I think it's all about because a lot of us, we're lucky, we've all got different niches, so what will happen is we will look, and we'll think that case would be best suited if that person's got the most experience. And as seniors, you get the most complex work in the team. (SW 22)

Negotiation and relationship building

‘You've clearly had some real issues in the past, and I'm not making light of those. I don't know about them, maybe you've got cause there, but none the more for that, I have to insist on seeing this lady in her own home’.(SW 20)

Creativity

• Arranging meetings outside the home– day care centre– local shops– Parks– libraries, – picking up the adult at risk in their car while they are out and driving them to their

office.

• Working with the extended family• Identifying individuals entering the home (e.g. care workers) and asking for their

support• Conducting therapeutic family counselling• Accessing further information about the family’s background from their

networks

Creativity

…if the hinderer has moved in, establish where they came from by checking with for example, the Department of Work and Pensions, the Land Registry, neighbours, family, milkman, community centre and church. (SW 04)

Managing risk with social work colleagues

…so we'll all sit down and we'll all pick it apart like we're doing now, and we'll make a decision, do we go forward in this way, so I don't think it could be something that could be used in isolation, unless it was a dire emergency. (SW 16)

I think it's all about the person's experience, and I think it's all about because a lot of us, we're lucky, we've all got different niches, so what will happen is we will look, and we'll think that case would be best suited if that person's got the most experience. And as seniors, you get the most complex work in the team. (SW 22)

Informal and formal multi-agency approaches

• ‘But very often if you're with the police, and they see someone in uniform, that seems to be enough to, to give me the authority to walk in.’ (SW 03)

• ‘I think working with the police is difficult. […] And then trying to engage with the allocated worker that would have raised that safeguard is very difficult because the shift work doesn't match social care shift work. So it goes round... the communication is lost; you go round in circles for quite a while. And even for the here and now we call 999 (emergency number) if we want police support; even that takes time, because we're not a priority’. (SW 19)

• ‘Local authority (was) trying to gain access to the property for some time [denied by a family member] to carry out essential electrical works and asbestos testing. Involvement of council officers, inspectors, electrical engineers, housing officers.’ (SW 18)

…and information sharing

I advise my guys, quote the Care Act at them, and our information sharing agreements and you're all signed up to this, and what are your reasons for not sharing this information, and then obviously escalating it to the appropriate people, (local and national health bodies) if we're not actually getting that. (MGR 23)

So we've all got different systems, the police have their own system, different parts of health work on different systems, mental health work on a different system; unless we're all able to actually just have a view, we're not asking for in-depth information, but if you could get an overview, just get an overview or a risk indicator, anything would actually help, but it would have to be a two-way thing. (SW 21)

Conclusion

• Complex hinder situations rare but very resource intensive when they arise

• Distinction between approach with previously unknown and known adults at risk

• Balancing practice wisdom with legal and policy structures

• Guidelines for practice and multiagency working required

• More data collections and research to identify size of the problem

Thank you for listening!

Research team:

• Martin Stevens – martin.stevens@kcl.ac.uk

• Stephen Martineau – stephen.martineau@kcl.ac.uk

• Caroline Norrie – caroline.norrie@kcl.ac.uk

• Jill Manthorpe – jill.manthorpe@kcl.ac.uk

Helping or hindering in adult social care

Project website: http://www.kcl.ac.uk/sspp/policy-institute/scwru/res/capacity/helping-or-hindering.aspx

Discussion Questions

1. Experiences of hindering a) What was the contextb) What were the risksc) Support from other social workers and managersd) Support from colleagues in other agenciese) What difference (if any) would increased legal powers have made? f) Resolution?

2. How much of a problem is hindering?3. Are there any examples of existing local data gathering that could capture

information on numbers?4. How could further data collection be developed?5. Particular challenges in gathering evidence