7. Supporting adults with learning disabilities and/or autism to stay safe

The Care Act 2014 places a responsibility on councils to protect people who are at risk from abuse or neglect.


7.1 Introduction

The Care Act 2014 places a responsibility on councils to protect people who are at risk from abuse or neglect (Sections 42 to 47 of the Care Act 2014). Many public services play a key role in helping people, including adults with LD&A), to keep safe. It is important for local services to work together to identify individual people who are at risk and to take steps to protect them. However, for adults with LD&A it is important to guard against being risk averse. This can prevent people from realising their full potential and can be inappropriately restrictive.

7.2 What good looks like

The best councils fulfil this responsibility by pursuing positive risk management practices. This involves proactive identification and mitigation, instead of trying to eliminate risk. In so doing, they fulfil their protection responsibilities without unduly restricting how individual adults with LD&A live their lives. Rather they enable people to take reasonable managed risks so they have choice and control over their lives and can be as independent as they individually can be. They:

  • Provide strategic leadership and work with other public agencies and other local stakeholders to agree the local strategic approach to enabling adults with LD&A to keep themselves safe.
  • Provides information and advice in a range of accessible formats to help adults with LD&A and carers to understand how to identify different types of abuse and neglect and to advise them how to mitigate each risk and what to do if they are concerned about abuse or neglect.
  • Ensure professional practice consistently manages risks positively so adults with LD&A can live the life they want with proportionate and least restrictive responses to mitigate risks.
  • Work co-productively with local communities to make them safer for people with LD&A and to increase public awareness of possible signs of abuse/neglect and to know how to report concerns.
  • Work with organisations providing support to adults with LD&A to ensure they support people to stay safe while: enabling positive risk taking, always using the least restrictive support option(s) and by making support available for people who have experienced abuse or neglect (or witnessed it) so they can access and benefit from participation in the criminal justice system.
  • Operate efficient and effective safeguarding arrangements that fully involve the person experiencing, or at risk of, neglect/abuse - as far as this is practical in each case.
  • Ensure independent advocacy is available to all who need it and ensure it is used effectively to support people who are currently or have recently experienced abuse. This includes independent advocates for Mental Capacity (IMCA), Domestic Abuse (IDVA) and Mental Health (IMHA).
  • Minimise COVID-related risks by ensuring that the individuals they support, informal carers, and care and support providers are all supported to understand and follow the latest hygiene and social distancing best practices to minimise COVID related risks.

7.3 Expected outcomes

In terms of outcomes councils that are implementing good practice should find that adults with LD&A are more able to keep themselves safe, are involved in less safeguarding incidents, and experience less crime in their local communities, including hate crime against adults.

Adults with LD&A, in receipt of support, have a better and safer experience of being supported by providers and by other organisations. They agree that they feel safe and secure in their everyday life, and that the services that support them help them feel safe and secure.

Support arrangements will consistently use the least restrictive options possible.

More people (Including carers/representatives) who experience a safeguarding enquiry are treated sensitively and with dignity and respect. Specifically, they:

  • Are involved in defining the outcomes to be achieved from the enquiry process and eel the desired outcomes from the enquiry process were achieved.
  • Are involved in understanding and analysing the risks involved, agreeing an acceptable level of risk, and planning appropriate mitigation plans.
  • Understand the safeguarding enquiry process and feel listened to throughout the process.
  • Are satisfied with the result of the overall safeguarding enquiry process.
  • Feel safer following the safeguarding enquiry process.

Adults with LD&A have equal access to effective criminal, civil or social justice, to resolution and recovery and the rates of success when prosecutions are sought will be improving.

7.4 Supporting adults with LD&A to keep themselves safe performance indicators

Outcome indicators

Outcome indicators

Aim

National/Local

ASCOF (4A) - Proportion of people who use services who feel safe - Separate out adults with LD&A.

Increasing percentage

National data

ASCOF (4B) - Proportion of people who use services who say those services have made them feel safe and secure - Separate out adults with LD&A.

Increasing percentage

National data

Trend in recent years in the level of hate crime (number and per ‘000 people in adult population with LD&A) in the area against adults with LD&A

Decreasing rate ‘000

National data

Analyse CQC ratings of local services in detail: Monitor the percentage of providers rated “Outstanding” or “Good” for the key line of Inquiry on “Are they safe?”

Increasing percentage

National Data

 

Individual experience indicators

Individual experience indicators

Aim

National/Local

As per Making Safeguarding Personal – An Outcomes Framework (2018): Ask adults with LD&A involved in safeguarding processes and/or their carers questions about how involved they were, whether their desired outcomes were achieved, how well they understood proceedings, how well risks were managed, their satisfaction with the process and whether they feel safer after the safeguarding enquiry process than before?

Calculate the percentage of outcomes achieved in each outcome domain. (See Part 11 see Annex 2)

Percentage of “outcomes” achieved should increase year on year.

National data

 

Financial value for money indicators

Financial/Value for Money Indicators

Aim

National/Local

Monitor trends in current gross expenditure on safeguarding including total expenditure on safeguarding:

 

Local data

Per head of the population aged 18-64 benchmarked against comparable councils

Reducing %

Local data

Per adult with LD&A with care and support benchmarked against comparable councils

Aim to be around 50th percentile for England

Local data

Per adult with LD&A in the population benchmarked against comparable councils   Local data
Over a five-year period as a percentage of total ASC expenditure   Local data

 

7.5 Self-evaluation questions

How to rate yourselves against the self-evaluation questions:

For each chosen section the DASS should consider each statement about good practice that follows and work with their senior management team, representatives of key partner organisations and local experts by experience to rate how close the council’s approach to supporting adults with LD&A is to the best practice described using the following 5 point scale, where 1 means it is far away from best practice and 5 means it is already using best practice.

The scale to be used is as follows:

1. Commitment

The importance of this best practice has been recognised. Conversations are taking place internally or with partners including experts by experience, but work has yet to begin.

2. Developing

Work on this best practice has commenced internally or with partners including experts by experience, but it has yet to be signed off, is only in the planning stages and with resource identification is still in progress.

3. Implementation

An agreed fully resourced and commissioned (where relevant) plan is in place. Implementation has started, but best practice is not yet fully operational.

4. Operational

Best practice is in place and is being used, albeit implementation is at an early stage, and further refinements in line with the learning from implementation may be needed before expected benefits are fully realised.

5. Sustainable Delivery

Best practice is in place and is working well. Long-term funding, resources and structures are in place i.e. best practice now represents “business as usual” and continuous improvement processes are in place.

Supporting people to keep themselves safe

Supporting people to keep themselves safe

Score 1 - 5

Basis of score

1 The council provides strategic leadership and works with public agencies and other local stakeholders that are a part of the “Whole System” of care, support health and housing in the area to gain agreement about/commitment to the local strategic approach to enabling adults with LD&A to keep themselves safe. This includes:

  • Embedding safeguarding into the council LD&A strategy and encouraging key partners to do the same.
  • Appointing a strong adult safeguarding lead with an appropriate level of seniority to achieve improvements across the full range of council activities/functions not just adult social care and encouraging key partners to do the same.

 

 

2 The council provides information and advice in a range of accessible formats to help adults with LD&A and carers to understand how to identify different types of abuse and neglect and:

  • Advises them how to mitigate each risk to stay safe.
  • What to do if they are concerned about abuse or neglect.

 

 

3 The council ensures professional practice ensures that risks are managed positively so that adults with LD&A live the life they want to and use proportionate/least restrictive responses to mitigate risks by ensuring ASC staff who work with adults with LD&A understand:

  • Their legal safeguarding duties.
  • That safeguarding plans should enhance the liberty of people by using proportionate/least restrictive practices and by fully involving the individual at risk as per ‘Making Safeguarding Personal’.
  • That when there are children in a household both the adults and children may be experiencing abuse there is a need to work jointly with children’s services.

 

 

4 The council works co-productively with local communities to make them safer for people LD&A to access and to increase public awareness of possible signs of abuse and neglect and how to report concerns.

 

 

5 The council works with organisations providing support to adults with LD&A to ensure they help the people they support to stay safe while enabling positive risk taking that always use the least restrictive support options by:

  • Ensuring commissioned services have good quality assurance arrangements and understand their safeguarding roles and responsibilities.
  • Using a wide range of information about commissioned services to quality assure and to risk assess the services of each provider.
  • Using contract letting and contract management and quality assurance systems to ensure that care and support providers always use the least restrictive options
  • Providing info/advice including at regular forums to providers about complex issues such as the Mental Capacity Act 2005.
  • Ensuring adults with LD&A have access to “Safe places” in the community
   
6 The council works with family and informal carers and with personal assistants and provides them with information and support to ensure they help the adults with LD&A who they support to stay safe while enabling positive risk taking that always use the least restrictive support options. This includes the accreditation of Personal Assistants. It should ensure and check that they understand their safeguarding roles.    
7 The council ensures independent advocacy is available to all who need it and ensure it is used effectively to support people who are currently or have recently experienced abuse. This includes independent advocates for Mental Capacity (IMCA), Domestic Abuse (IDVA) and Mental Health (IMHA).    

8 The council operates efficient and effective safeguarding arrangements that fully involve the person experiencing or at risk of neglect/abuse as far as this is practical in each case. Specifically ensure the:

  • Partners in the Safeguarding Adults Board (SAB) have clear role/responsibilities.
  • The SAB leads and co-ordinates the delivery of Adult Safeguarding policy and practice across all agencies.
  • People being safeguarded are involved in defining their own outcomes in each case
  • Number/type of safeguarding alerts, enquiries etc. involving adults with LD&A and the outcomes and learning from them e.g. from serious case reviews are monitored.
  • Quarterly reports on safeguarding are considered by the DASS and SMT and improvement actions are implemented when needed.
   

9 The council ensures accessible information is available for adults with LD&A about how to minimise COVID-19 related risks including how to:

  • Stay remain socially distanced, and
  • Use practical personal hygiene measures to minimise COVID -19 related risks.
   

10 The council ensures all providers have access to and are implementing the latest information/guidance on how to minimise COVID-19 related risks including how staff can:

  • Use personal protective equipment appropriately,
  • Provide services in socially distanced ways,
  • Use practical personal hygiene measures to minimise COVID -19 related risks, and
  • Enable the people they support to keep themselves as safe as possible from COVID-19 whilst still living an active life.
   

 

Safe Places schemes

Safe Places schemes help adults with learning disabilities cope with any incident that takes place while they are out and about, for example being harassed, getting lost or the person they are meeting fails to turn up which causes them to need assistance. The idea is simple: Businesses and organisations sign up to be a Safe Place.  After training they are issued with a Safe Places sticker which they display in their window.  People with a learning disability become members of the scheme and receive a distinctive wristband together with a card.  The card has space for scheme members to write their name, together with the telephone numbers of up to three people who can be contacted in an emergency.

Who is good at this?

Hammersmith & Fulham Council, along with partner organisations, and the Safeguarding Adults Board (SAB) have developed arrangements which demonstrate that safeguarding can go beyond protecting people to also make a positive contribution to helping them to live the lives they want to live. Key elements are:

  • effective SAB with senior staff from all key partner organisations with a shared vision for safeguarding in the area
  • facilitative and inspirational leadership, committed to making safeguarding accessible and relevant
  • clarity that safeguarding is everybody’s responsibility and keeping people safe should be a routine part of all interactions whilst also using specialists in a safeguarding hub
  • making sure that prevention is given the same importance as investigation
  • clear pathways and effective structures
  • identification of highest risk situations
  • emphasis on person centred practice: involving the person who is subject to safeguarding in determining the desired outcomes and that their best interests drive decision making
  • routine use of data to monitor activity and, importantly to inform improvement
  • supplementing supervision with opportunities for reflective practice.

See video case study in Hammersmith and Fulham Safeguarding Adults Board Annual Report 2018-19

Guidance

To help staff improve how they support people to keep themselves safe see: BILD 2015 guidance: Unprotected, over protected - Practice Guide: Supporting Professionals to meet the needs of young people with LD who experience, or are at risk of, child sexual exploitation

To understand how to improve local safeguarding arrangements see: ADASS Safeguarding Improvement Tool (2015) 

To understand how to improve how adults with LD&A experience of safeguarding processes see: Making safeguarding personal (2018)

To understand what safeguarding capabilities the social work workforce needs, see the two capability statements for social workers by DHSC/BASW. They are on working with:

To find a wide range of guidance about how to better support people for adulthood throughout their childhood see: Quick Guide: Commissioning for transition to adult services for young people with SEND: NHS England (2018)

For the current guidance on COVID safe care and support go to the SCIE COVID hub