The placing of safeguarding adults onto a statutory basis via the Care Act 2014 (the Act) was something that had been long campaigned for by a number of professions, agencies, organisations and individuals representing service users, their carers, practitioner and academics across the statutory, voluntary and independent sectors. Since the publication of “No secrets” by the Department of Health in 2000, there have been numerous publications and research projects that have examined professional practice in and, to a lesser extent, the experience of service users and their carers of, safeguarding adults. Often, these were limited by the inconsistency in practice, structures and systems because of the lack of a mandatory basis in law to underpin them.
To a degree, the Act and its supporting statutory guidance have rectified this situation, and this book is an example of how a more rigorous approach can now be taken to provide an evidence base to support and inform good practice in this area. As is acknowledged within the book, it is still comparatively early in the implementation of the Act for a body of practice and legal precedents to have been established, resulting in some of the cases and examples pre-dating the Act. This is not, in itself, a major issue, as good professional practice remains good professional practice, despite changes in legislation and regulations.
The book covers a broad range of issues and approaches that are important and relevant to safeguarding adult practice, and raises some interesting challenges that need to be addressed as the Act and initiatives such as making safeguarding personal are embedded in practice, organisations and structures. I was a little unclear as to the target audience the editors were aiming for: professionals; practitioners; operational managers; strategic managers; academics; trainers; students? At PASAUK, we would include all of the above if safeguarding adults is part of their remit or job description, and I would suspect the same is true here.
However, the book includes a level of detail about parts of the Act – what Section 42 includes, for example – but ignores others, such as Sections 67 and 68 and the duty on local authorities to provide independent advocacy in certain circumstances where the individual has mental capacity. Some of the case studies do not, in my view, come under the remit of safeguarding under the Act, as one of them points out. At times, there is a confusion between the presumption and the assumption of capacity required by the Mental Capacity Act 2005 (the MCA), a confusion that, in my opinion, is often instrumental in the MCA being ineffectively implemented. Use is made of the terms “old people” and “older people” which, as someone in his late 60s, I find difficult if not offensive, as the terms are meaningless at best and stereotypical and ageist at worst.
If the personal is now political and safeguarding should be personal, it follows that safeguarding is also political. The book does not address the political context in which the Act was drafted and enacted; this is important as it can be seen as explaining the lack of clear definitions contained in the Act and its supporting statutory guidance – there is no definition of either abuse or neglect, nor of safeguarding – and the lack of prescription with regard to policies and structures. A government committed to reducing the size of the state provision and to a period of austerity in the public services could hardly do otherwise, but these have major implications for implementing the Act and multi-agency practice in particular. Some of the approaches outlined in the book, while examples of good practice, would be comparatively expensive to implement, and the need for the public sector to make ongoing savings while budgets are either cut or remain static makes it difficult to make person-centred practice and treating the service user as an equal partner a reality.
The Act was seen by the Department of Health as a means to achieving several goals, including a refocusing of safeguarding activity on those cases that really are safeguarding and to changing the culture in all agencies away from being risk-averse and service-led to being empowering of service users and needs-led, moving from talking and thinking about “risk to” service users to the “benefit for” service users. Some of the sections of the book, particularly those relating to modern day slavery and financial scamming, in my opinion, fall into the trap of broadening the focus of safeguarding adults practice. In fairness, of course, the Act’s statutory guidance advises local authorities to not be limited in how they define abuse and neglect, and areas such as modern slavery are included as convered by safeguarding, but this is hardly a recipe for focused practice! The book’s authors do make the important point, though often implicitly rather than explicitly, that the Act places duties on the local authority, not just on adult social care: safeguarding adults is not just the responsibility of one agency or even one department or service within that agency; nor is it the responsibility of a single profession.
The above should not be seen as suggesting this book is not an important contribution to the development of safeguarding adult practice; the book contains a wealth of valuable ideas for enhancing safeguarding adult practice for the benefit of service users, their carers and those who work to support them. It is, however, a suggestion that the book would have benefited from an acknowledgement of the political and economic context in which practitioners have to respond to potential and actual safeguarding cases and that, just as safeguarding practice should empower service users to have more control over their lives, even if this means living with an increased level of perceived risk, practitioners need to be empowered and supported by quality professional supervision to exercise professional judgement in their response to safeguarding situations.
The book, and the Act, recognises that for safeguarding adults to become really person centred requires a change in culture, not just from practitioners but also from managers – both operational and strategic. Ideally, the audience for this book will also include elected members with responsibilities for health and social care to ensure that the change in culture is as far reaching as possible.
