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.

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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.

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.

Councils investigated more adult safeguarding cases involving self-neglect and domestic abuse last year, but carried out fewer enquiries overall, despite a rise in referrals, show official figures.

The number of concerns reported to local authorities rose by 5% to 498,260, reported NHS Digital’s annual safeguarding adults collection, published last week. However, the number of enquiries fell by 5% to 168,960, with a 6% drop in statutory investigations under section 42 of the Care Act 2014.

The number of completed section 42 enquiries fell or was stable in most categories of risk, with neglect and acts of omission remaining the most common form, accounting for 61,190 cases, down from 65,590 in 2019-20.

However, the number of completed domestic abuse enquiries rose by 28%, from 10,825 to 13,880, with a 26% rise in those concerning self-neglect, from 10,245 to 12,920. There was also a significant jump in cases concerning sexual exploitation, though from a low base.

Under section 42, an enquiry is triggered when a local authority has reasonable cause to suspect an adult with care and support needs is experiencing, or at risk of, abuse or neglect and is unable to protect themselves because of their needs.

Domestic abuse rise ‘reflects national picture’

Liz Howard, the British Association of Social Workers (BASW) England’s professional officer for adults, said the rise in domestic abuse cases “sadly reflects the national picture” during Covid-19.

“We, along with many charitable organisations and women’s groups, have consistently been raising awareness and pressing government to do more to help victims of domestic abuse as we saw in our research that incidents spiked during lockdown periods,” she said. “The increase in self-neglect could be linked to delays in accessing support because of fears of contracting Covid-19.”

Howard said of the rise in the overall number of referrals: “It is impossible to attribute this to a single factor, but it is clear to see in society and in the media, as well as from member feedback, that there is a greater awareness of people’s welfare – particularly the elderly, vulnerable and solitary adults – during the pandemic. We believe this is leading to more referrals to professional services.”

She said the fall in enquiries was “likely to be linked to changes in local working arrangements and processes during the pandemic”.

“We believe this also relates to differences in practices and application of statutory duties across local authorities, such as application of the threshold and how activity connected to safeguarding is being recorded,” Howard added.

In 89% of completed section 42 enquiries where a risk was identified, it was either reduced (64% of cases) or removed (25%), similar to levels in 2019-20.

In cases where the preferred outcome of the person was known, this was achieved fully in 67% of cases and partially so in 26% of cases. Practitioners asked people about their preferred outcomes in 77% of cases.

Howard said this “demonstrates that action being taken with adults in terms of safeguarding is effective and working well for people”.