Social care practitioners can get up to speed with the law around adult safeguarding at Community Care’s next masterclass.

Expert speakers will cover issues including the legal framework around adult safeguarding, its intersection with the Mental Capacity Act 2005 (MCA), the inherent jurisdiction and how to handle cases involving self-neglect or hoarding.

Alongside this, delegates will also learn the key lessons for practice from the safeguarding adults reviews (SARs).

The masterclass, which costs £325 plus VAT, takes place on 28 March 2025 at etc.venues, Manchester.

The adult safeguarding event builds on the success of last year’s legal masterclasses, in Manchester and London, on mental capacity.

Speaking at the adult safeguarding masterclass are:

• Tim Spencer-Lane, a lawyer specialising in adult social care, mental capacity and mental health, who will provide an overview of the legal framework around adult safeguarding in England and Wales, including the criteria for a safeguarding enquiry and the protection powers available to practitioners.
• Professor Michael Preston-Shoot, an academic specialising in adult safeguarding, who will share learning from the second national analysis of SARs, which he co-authored.
• Francesca Gardener, a specialist Court of Protection barrister from 39 Essex Chambers, who will discuss the inherent jurisdiction of the High Court, explaining the limits of its power to protect vulnerable adults sharing learning from key case law.
• Rebecca Clark, a barrister from Exchange Chambers, who will speak on the application of the MCA to adult safeguarding cases.
• Neil Allen, a barrister at 39 Essex Chambers and senior lecturer at the University of Manchester, who will help practitioners navigate the complex ethical dilemmas when deciding whether or not to intervene in self-neglect and hoarding cases.

You can find out more, and book your place, on our dedicated masterclass website.

by Ruth E Hare

Ruth E Hare is a senior practitioner in Birmingham City Council’s quality and practice learning and hoarding teams and was named adult social worker of the year at the 2023 Social Worker of the Year Awards.

08:30 – I log on with a cup of tea and read through my emails and notifications.

09:00 – We have our weekly team brief over Microsoft Teams. I manage the hoarding team – a sub-team of the adults’ service student unit – so we share updates and discuss key issues affecting the students.

One that comes up is the number of safeguarding referrals coming through. Our team manager leads a discussion on how the unit can best aid our hoarding team and we agree on increasing support around processing referrals. The student unit’s team manager will also be helping me manage and close safeguarding referrals down when appropriate.

The team briefing ends with a welfare check, where the chair enquires about everyone’s wellbeing. I find it is a good opportunity for members to offload and say how they are feeling with work or any pressing personal issues.

10:00 – As the onsite supervisor, I have midpoint reviews for two of the students on my team after the team meeting.

It is lovely to learn how well the students are doing. They have positively developed their relationship-building and person-centred skills, which are essential for working with citizens who hoard.

A specific case is mentioned where the student, through persistence and person-centred work, successfully engaged a citizen to agree to a clean-up of his home. We also touch on the skills that need further developing, with a focus on complex Care Act assessments.

12:00 – I take an hour-long lunchbreak today.

Pictured: Ruth E. Hare

13:00 – I go through referrals and make a decision about which I can accept. I then make some phone calls to citizens we work with to arrange interviews for the research I am conducting about outcomes of interventions for citizens who hoard. It is a short piece of qualitive research with seven contributors.

14:00 – I have some time set aside for admin tasks, but I receive a phone call from a student who is at the hospital.

She is concerned that an unsafe discharge is about to take place, so we talk through the options available to her. The student then explains her concerns to the ambulance staff, who return the citizen back to the hospital.

We also discuss whom else she could alert about her concerns at the hospital. The discharge has been avoided for now but the hospital can still decide to discharge the citizen at any point. The student informs the citizen’s son about the situation before she leaves.

15:00 – I have a meeting with the commissioning team and our third-party organisation that specialises in hoarding. Their director acts as a mentor for the students.

We discuss various concerns, including waiting lists for both the third-party organisation and the hoarding team, and how we will manage them.

There is a discussion about whether consistency in staffing is important in relation to waiting lists, and how funding and budgets affect our ability to retain and hire staff.

16:00 – The day ends with a catch-up with my team manager, who supported me while I was on annual leave the previous week.

We go through some of the issues that were raised in the meeting today and come up with a clear set of actions for the hoarding team.

We agree that I will prioritise the safeguarding forms that have been sent through and discuss how I can best manage my time so that I can effectively balance out my work and home life.

17:30 – I finish off with a phone call to the student to discuss her learning from the incident earlier in the day and to get an update on the citizen. I am told she has been taken home with the support of her son.

I reassure her that she is doing well and state how impressed I was with her actions.

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For our 50th anniversary, we’re expanding our My Brilliant Colleague series to include anyone who has inspired you in your career – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by either:

• Filling in our nominations form with a letter or a few paragraphs (100-250 words) explaining how and why the person has inspired you.
• Or sending a voice note of up to 90 seconds to +447887865218, including your and the nominee’s names and roles.

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

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During my assessed and supported year in employment (ASYE), I was struck by how consistently ‘improving emotional resilience’ came up as a personal development goal.

Social work is known for being a demanding profession, requiring a great deal of emotional intelligence. The potential for vicarious trauma from supporting adults in extreme distress was something I was prepared for during the specialist mental health social work training scheme I undertook.

What I felt ill-prepared for was the unspoken need to balance the needs of the adults I support with those of the under-resourced organisation that employs me, which have frequently clashed.

Feeling conflicted

I found myself conflicted by the dual responsibility to deliver care and support tailored to each person’s circumstances, whilst managing a continually growing waiting list that was becoming unmanageable.

This tension has been particularly acute in my work with adults experiencing hoarding and self-neglect. This has provided some of the most enjoyable and rewarding experiences of my first year in practice – but also significant anxiety.

Research is clear that gradual, long-term, creative relationship-building is vital to securing sustainable outcomes for this group of adults, who frequently struggle to engage with services or reject support (Barnett, 2018).

Deficits in self-neglect practice

Such research also notes that this approach is still insufficiently practised; what you get instead are short-term, risk-averse and often traumatising interventions, such as ‘blitz cleans’.

Insufficient use of mental capacity legislation, including applications to the Court of Protection, is one of the most commonly noted practice deficits in self-neglect cases (Local Government Association, 2020).

Consequently, adults who may lack capacity to make decisions regarding their hoarding or self-neglect and who are at significant risk of harm have been erroneously discharged from services due to ‘non-engagement’ (Preston-Shoot & Braye, 2017).

In my experience, this stems from a stark inability for current statutory services to provide the long-term, time and resource-intensive work that is needed for many adults experiencing these difficulties.

Facing resistance from management

This can be seen at the statutory mental health service I work for, where waiting times reach up to 15 months.

When attempting to complete assertive outreach work with an adult who had experienced longstanding self-neglect and was both very averse to support and at high risk of harm, I experienced resistance from management.

This involved conversations about how the time taken working with this adult could have been spent supporting many more service users who “wanted to engage”.

Second-guessing yourself

Consequently, when making a lengthy application to the Court of Protection for another adult who lacked capacity to maintain her home safely due to hoarding, I found myself repeatedly second-guessing the need for such a time-intensive intervention.

I started to wonder whether I was erroneously prioritising individual interventions over offering support to the greatest number of people possible.

I doubt I am alone in feeling pressure to close cases early because of my caseload.

A recipe for burnout

What resulted throughout my ASYE year was an undercurrent of anxiety, low confidence in my own decisions and poor satisfaction with the work I was achieving – a perfect recipe for burnout.

Guidance from supervisors when I reflected on this anxiety was that I was internalising a service level pressure that was above my responsibility to manage: hence, the consistent drive to improve my resilience.

Yet, such a focus on individual resilience has been criticised as a neoliberal transference of responsibility from organisations to social workers (Garrett, 2015).

In other words, the burden often falls on practitioners to respond to circumstances in need of wider system change, rather than on organisations to make these changes.

I struggle to understand how social workers can communicate this state of affairs to those they support. When ending work with at-risk adults early, how do we ensure that is not perceived as them not struggling ‘enough’ for services to support them?

‘Good enough’ social work

How do we make clear the impact of limited resources on the extent of support we offer, without transferring the overwhelm we feel as a service and thereby eroding a sense of safety within public services?

Donald Winnicott (1953) spoke about ‘good enough’ parenting as a sustainable alternative to striving to provide a perfect, and impossible, experience of childhood. Pursuing ‘good enough’ social work – practising in the best means possible within the constraints of resources available – offers a coping strategy for practitioners.

But this only goes so far.

What is desperately needed is systemic change, backed up by the increased resources for statutory services that so many have demanded, over so many years, to no avail.

What I fear will continue to happen without this is that more practitioners will burn out and ‘vote with their feet’, exacerbating staff shortages and deepening the crisis in our services.

The Mental Capacity Act 2005 is a critical pieces of legislation, employed every day by social care practitioners working with people aged 16 and over.

But with case law and practice contexts continuing to evolve, staying up to date with the MCA is vital to legal literacy in social work and occupational therapy.

That is why Community Care has invited some of the leading legal authorities on the act to deliver a masterclass on it in Manchester, on 13 March 2024.

Barrister, trainer and writer Alex Ruck Keene KC (Hon) will open the day with an update on the latest key cases from the Court of Protection.

Handling complex cases

He will also provide guidance on handling cases involving complex capacity assessments and best interests decisions.

Alex’s colleague at 39 Essex Chambers, Neil Allen, will follow this with a session on the application of the act to hoarding cases.

Neil will draw upon the judgment in AC and GC (Capacity: Hoarding: Best interests) [2022] EWCOP 39, the first Court of Protection ruling on hoarding, in which he appeared.

He will cover, among other things, the relevant information for the purposes of a capacity assessment when it comes to a person making decisions about their items and belongings.

Executive functioning difficulties

Neil will also deliver the next session, on the challenge of conducting capacity assessments of people with executive functioning difficulties. These may mean that a person may appear to have capacity to make a decision but may not, in practice, be able to carry the decision out.

He will highlight the importance of using real-world observations, in some contexts, and focusing on the person’s ability to use and weigh information as part of the capacity assessment.

After lunch, Ben Troke, author of A Practical Guide to the Law on Deprivation of Liberty (Law Brief Publishing), will examine the state of the law on deprivation of liberty.

Ben, who is a partner at the firm Weightmans, will look at how to understand deprivations of liberty in context and the importance of focusing on a person’s rights to private and family life, as well as to liberty.

Consent to engage in sexual relations

Next up will be Lorraine Kavanagh KC, whose session will cover the assessment of people’s capacity to engage in sexual relations and contract a marriage.

This will cover the relevant information for each assessment, and circumstances where assessing capacity to engage in sex is person-specific, not act-specific.

Rounding off the day will be a session from Community Care Inform’s legal editor, Tim Spencer-Lane, on the challenging topic of the interface between the MCA and the Mental Health Act 1983.

This will cover recent case law on the interface, as well as options for reforming it.

Joan has early onset dementia. She has always lived independently, but some concerns started to be raised that Joan was no longer managing so well. She had stopped going out, and her house had become cluttered and unclean.

Joan’s landlord wanted to evict her and Zoey, a senior social worker in Hampshire Adults’ Health and Care, began working with her.

It appeared that Joan had care and support needs, but she was reluctant to have a social worker involved and Zoey was finding it hard to get in contact.

But through an initiative Hampshire launched just over a year ago, called the Enhanced Support Project, Joan got access to support that helped Zoey gain her trust and work in a strengths-based way to help Joan turn her life around.

The Enhanced Support Project (ESP) was set up for people who struggle to engage with services, and where safeguarding risks relating to self-neglect are increasing without the person receiving the support they need.

Learning from a Safeguarding Adults Review led to the service being developed as “a better way to engage with people who could be forgotten because of non-engagement,” says Donna Harrison, head of service for learning disabilities, contact centre and MASH adult social care.

The Enhanced Support Project (ESP) workers are able to work intensively to build rapport and put plans in place that limit risk by involving the community and using least restrictive options and strengths-based approaches.

Specialist providers

This development has improved social work practice across Hampshire in partnership with two specialist providers – Richmond Fellowship and Home Group.

Referrals into the project are first of all measured against risk criteria. “These include signs of self-neglect, hoarding, difficulty engaging with services or a history of not engaging, and evidence that risks are escalating,” says Zoey, who has worked on the project since its launch.

This information is passed on to Richmond Fellowship or Home Group so they can start providing intensive and focused work to build relationships with individuals and identify their support needs. Once open, cases are then reviewed every two weeks to make sure continued needs and risks are properly understood and the right level of support is in place.

“Individuals needing this degree of support tend to have challenges linked to physical or mental health, substance misuse or domestic violence,” says Zoey.

Underpinning the entire project is a person-centred and trauma-informed approach that includes making sure the views and wishes of people being supported are as well-understood as possible and are clearly shared at every meeting.

Individuals needing support may have physical and mental health challenges. Photo: Evrymmnt/AdobeStock

Community involvement

Hampshire County Council works closely with colleagues from specialist health teams and primary care services like GPs, as well as fire services, housing associations and environmental health to build up a tailored picture for each person being supported by the ESP.

Taking a multi-agency approach under section 42 of the Care Act 2014 or the multi-agency risk management (MARM) framework means that where there are complex scenarios, for example, involving substance dependency or families, other key agencies such as education, children’s services or the NHS can be ready to step in and offer support.

Risk plans can also involve support from the local community. Donna gives an example of a risk mitigation plan for John, a man who is currently street homeless. Hampshire Adults’ Health and Care has been able to establish a robust risk plan for John with local shop owners, street pastors and town rangers to offer outreach support, ensuring that his basic needs are met.

This includes shop owners keeping an eye out for him and having a contact to report any concerns, including if they have not seen him in his usual areas or if he has not been into the shop for a few days.

“This approach has been a really good example of the community working together and with John to achieve the outcomes he wants,” says Donna.

The impact of the approach Hampshire Adults’ Health and Care take, using the ESP and multi-agency, strengths-based practice, is seen in improved outcomes for people. “Getting direct feedback from people with experiences of these services is really important to us,” says Donna.

One example is an email recently received from Tanya, who had been supported by the ESP.

“Since being under the care of this amazing initiative, I have managed to claw my way back somewhat from the brink and am now beginning to see the hope for regaining my life and purpose,” Tanya says. “This has not been without setbacks but luckily, every time a new challenge presents itself, the team is there to guide me through…[It is a] truly lifesaving endeavour”.

Balancing risk and human rights

But this project is not without its challenges.

Practitioners are constantly having to tread the fine line between minimising risk to an individual and upholding their human rights to ensure that these are protected.

It can be tricky because some of the people who are supported own their own property and are not obliged to engage or co-operate with adults’ health and care, says Zoey, who has been with Hampshire for 25 years, eight of which have been in the MASH team.

But having a “clear and evidence-based” focus in risk assessments is key, she adds.

Practitioners use Hampshire’s risk assessment and escalation framework, which has been developed to support practitioners and safe decision-making around risk. The risk assessment tool supports discussion and records individual risks for a person and what is in place to mitigate them.

An escalation framework ensures practitioners are supported with shared decision making for complex risks, drawing on relevant expertise as needed within the council and from partner agencies.

“We are clear on what the harms and the potential harms are and accepting how people may want to choose to live,” says Zoey. “But [we are also] making sure we are opening up opportunities for individuals and engaging with all the right agencies as best as we can”.

For the most complex risks, practitioners can seek guidance from a risk panel. This includes heads of service and assistant directors, who can provide escalation routes to other services, such as legal, health and police, if required.

Training

Hampshire has developed internal training around hoarding and self-neglect. Photo: ronstik/ AdobeStock

Hampshire has developed internal training around hoarding and self-neglect. There is also strengths-based practice training and the sharing of best practice between teams, explains Gillian Williams, the service manager for the Contact, Assessment and Resolution Centre (CART) & MASH.

“And we do a lot of work with our case workers and senior case workers about understanding what strengths-based approaches need to look like because it’s not always around commissioned services – it’s about what that person wants and how we work with that person,” she adds.

Practitioners are also supported by hoarding forums, which are led by some of the local district councils’ own housing providers and are an opportunity to stay informed and share best practice examples.

Through the ESP, Hampshire has successfully engaged with about 75% of the 170 cases it has been involved in in the past year.

Joan, the lady Zoey is supporting, is one of them. The team has been able to involve Joan’s GP, and a community nurse visits regularly to carry out blood tests and check-ups.

Joan also has been given assistive technology, such a pendant, and has agreed to have her hedges removed from the front, which means she can open her front door.

“It’s just trying to work at the person’s pace to gain their trust and engagement,” says Zoey.

“It’s positive breakthroughs like this that make the work rewarding,” adds Donna.

Hoarding can be described as the collecting of, and inability to discard, large quantities of, goods, objects or information. It may involve neglecting aspects of the home and/or self, resulting in poor sanitary conditions and social isolation.

Hoarding has implications for physical and mental health, wellbeing, housing tenure and safety, which is why intervention to help the person change their hoarding behaviour is so important.

The earlier the intervention, the easier it is for the person to consider change.

When working with someone who hoards, seek to:

1. Develop a rapport.
2. Find activities, work or education that the person enjoyed doing and try to help them engage in community activities.
3. Understand what feelings the person has about themselves, their house and why things are the way they are.
4. Use a strengths-based approach to determine the positive things that a person has in their life or can achieve for themselves and how they would like to manage risk.
5. Consider trauma-informed approaches and methods of motivation and communication.
6. Create cognitive dissonance – the difference between the person and their behaviours – to help them see themselves more positively.
7. Take one small step at a time with lots of encouragement.
8. Use a multi-agency response.
9. Consider wider safeguarding issues such as hate crime, domestic abuse, anti-social behaviour, safeguarding other adults or children in the property or historical abuse.
10. Do not force change if at all possible.

Gaining a person’s trust and supporting them to make change often takes time. Social workers and occupational therapists should work with the pace of the individual concerned whenever possible. Where risks are identified, cases should not be closed because of a lack of engagement without a thorough risk assessment and alternative arrangements being made to continue supporting the person.