The Care Act replaces Serious Case Reviews with Safeguarding Adults Reviews from April 2015. New research provides lessons for housing providers on dealing with vulnerable tenants. By Imogen Parry.
Academic research and media commentary on Serious Case Reviews (SCRs) has focused primarily on deaths, abuse and neglect in institutional settings such as hospitals, care and nursing homes, for example Winterbourne View and mid Staffordshire hospital.
But my research found 30 per cent of publicly available SCRs were concerned with adults who lived in social housing, equally split between those who lived in general needs accommodation and specialist sheltered or supported housing. Many non-housing professionals are unaware that many adults at risk, including people with dementia and other mental health issues, learning and physical disabilities, live in non-specialist social housing.
SCRs are commissioned by Safeguarding Adults Boards (SABs) when there are concerns about adult safeguarding failures resulting in vulnerable adults not being adequately protected. Their primary aim is to enable lessons to be learned.
My research on these housing related SCRs in which vulnerable tenants were abused or neglected suggested six lessons for housing providers:
Internal: Housing providers should improve:
- data bases of all tenants ensuring that vulnerabilities are identified
- support and contract monitoring involving vulnerable tenants
- awareness of safeguarding by all staff and ensure effective reporting of abuse.
External: Housing providers are inhibited in their effectiveness in adult safeguarding due to:
- barriers to information sharing, often caused by negative attitudes towards housing staff
- high referral thresholds by adult social care
- failures of risk and capacity assessment and diagnosis by adult social care.
These findings have since contributed to, or provided backing for, five legislative or policy changes and initiatives.
Firstly, the Social Care Institute for Excellence (SCIE) published a new on-line guide on ‘Adult safeguarding for housing staff’ which has three intended audiences: front-line housing staff and contractors; housing managers andlocal authority social care staff. The guide draws extensively on the six lessons from my research.
Secondly, a new Housing and Safeguarding Adults Alliance has been formed, comprising leading-edge housing providers, professional and trade body representatives. Its aim is to encourage, assist, promote and recognise the role and contribution of the housing sector in safeguarding adults.
Of particular relevance to this article are the requirements that all housing providers should have clear operational policies and procedures in adult safeguarding, and that all housing staff must be: familiar with the six principles underpinning adult safeguarding; trained in recognising the symptoms of abuse; vigilant, and able to respond to adult safeguarding concerns.
This change addresses my research finding that a failure to refer abuse into safeguarding procedures was a contributory factor in the deaths or serious harm of half of the individuals studied. This was often due to a narrow, uninformed focus by the housing provider and erroneous beliefs that consent by the alleged victim is always necessary or that evidence is needed before making an alert or referral.
These requirements are a significant improvement to the current statutory guidance for adult safeguarding in England, ‘No Secrets’, which only included sheltered and supported housing in its references to the housing sector.
In addition, the implementation of sections of the Care Act and related draft statutory guidance regarding information sharing, co-operation, prevention and well-being should encourage housing providers to raise awareness of adult safeguarding with tenants, contractors and staff and to address some of the difficulties around partnership working identified in my research on SCRs. There is also emerging evidence of increased involvement of the housing sector in SABs.
However there are likely to be continuing grey areas for housing providers regarding adult safeguarding, despite the above welcome aspects of the Care Act. My research found that high safeguarding referral thresholds led to low level concerns being unaddressed by adult safeguarding procedures and this may not change, given continued local authority resource constraints.
Similarly, local variations in the inclusion or exclusion of self-neglect in safeguarding procedures are not currently addressed in the Care Act or related draft statutory guidance. This controversial policy area has been left to SABs to determine locally. There is also likely to be continued local variation and lack of clarity regarding the circumstances when service users’ refusal to consent to a referral should be over-ruled. Finally, there appears to be no central government agency direction to housing providers to improve their tenant data bases of vulnerability, which would address the first lesson identified in my research.
Fourthly, many housing providers are widening the scope of their adult safeguarding policies from a focus just on tenants living in sheltered and supported accommodation to all tenants, including those living in general needs accommodation. Some general needs housing providers now ensure that staff previously focusing ‘only’ on anti-social behaviour, rent arrears, evictions and other core housing management functions also consider domestic abuse, hate crime and adult safeguarding issues.
Fifthly, the recent House of Lords report on the Mental Capacity Act 2005 (MCA) echoed the sixth lesson of my research, which is that the MCA has suffered from a lack of awareness and understanding and from poor implementation. The government’s response included considering the case for establishing a new independently chaired Mental Capacity Advisory Board, commissioning a review of current guidance and tools on the MCA, requesting the Law Commission to consult on and potentially draft a new legislative framework that would allow for the authorisation of a best interests deprivation of liberty in supported living arrangements.
These changes are to be welcomed although it is regrettable that there is still no central government database of SCRs or mechanism to disseminate their lessons across different sectors.
The author recently published research on ‘Adult Serious Case Reviews: lessons for housing providers’. This article outlines the policy impact and relevance of that research.