Safeguarding adult reviews: informing and enriching policy and practice on self-neglect

Abstract

Purpose The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis and explore the degree to which SARs draw upon available research and learning from other completed reviews. Design/methodology/approach Further published reviews are added to the core data set, mainly drawn from the websites of Safeguarding Adults Boards (SABs). Thematic analysis is updated using the four domains used previously. The four domains and the thematic analysis are rounded in the evidence-based model of good practice, reported in this journal previously. Multiple exclusion homelessness and alcohol misuse are prominent in this sample of reviews. Findings Familiar findings emerge from the thematic analysis and reinforce the evidence-base of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners working with such cases. Multiple exclusion homelessness emerges as a subset within this sample, demonstrating that SABs are engaging in reviews of people who die on the streets or in temporary accommodation. Research limitations/implications The national database of reviews commissioned by SABs remains incomplete and does not contain many of the SARs reported in this evolving data set. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. NHS Digital annual data sets do not enable identification of reviews by types of abuse and neglect. It is possible, therefore, that this data set is also incomplete. Drawing together the findings from the reviews nonetheless builds on what is known about the components of effective practice, and effective policy and organisational arrangements for practice. Practical implications Answering the question “why” remains a significant challenge for safeguarding adult reviews. The findings confirm the relevance of the evidence-base for effective practice but SARs are limited in their analysis of what enables and what obstructs the components of best practice. Greater explicit use of research and other published SARs might assist with answering the “why” question, drawing attention where appropriate to policies being pursued by the central government that undermine any initiative to end rough sleeping. Originality/value This paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further reinforcing the evidence-base for practice. The evidence-base also supports practice with individuals who experience multiple exclusion homelessness. Policymakers and practitioners have an approach to follow in this complex, challenging and demanding area of practice.

Learning from safeguarding adult reviews about Transitional Safeguarding: building an evidence base

“…substance misuse, alcohol misuse, child criminal exploitation and child sexual exploitation) (Holmes, 2022). Issues of “lifestyle choice” also feature in SARs regarding people who experience homelessness or are alcohol dependent (Alcohol Change UK, 2019; Preston-Shoot, 2020). However, when the person is aged 18–25 years, these “lifestyle choices” convey a wealth of unique meanings and prejudices.…”

On (not) learning from self-neglect safeguarding adult reviews

“…Only one review (323) referred explicitly to the quality markers. This review noted the exclusion of an agency, the Department for Work and Pensions, from the process but referred positively to the involvement of individuals with lived experience and to the homeless fatality review process (Preston-Shoot, 2020). Also positive is one SAR's observation (319) that family members were surprised at how in-depth the review had proved and how much they felt in control of the process; in another (303), IMRs were "honest".…”

“…This article continues to update the database of safeguarding adult reviews (SARs) in which self-neglect features (Braye et al, 2015a(Braye et al, , 2015bPreston-Shoot, 2016, 2017, 2018, 2020. The absence of systematic data collection nationally, regarding the types of abuse and neglect featuring in reviews, has meant that it has not been possible hitherto to state with certainty whether the increasing volume of SARs featuring self-neglect was mirrored by those focussing on other types of abuse and neglect.…”

Three early papers on self-neglect

“…Finally, while under the Care Act 2014 age no longer occupies the place it once did in thinking about self-neglect, it is a peculiarity of the Act's guidance that it indicates in its glossary of terms that refusal of assistance is a necessary component of self-neglect (in this, the guidance's definition is awkwardly split across the main body of the document and its annexes: (Department of Health and Social Care, 2020) [2]. While this is how a proposed definition of self-neglect was presented in the research cited in the guidance (Braye et al, 2014, p. 191), subsequent work by the same authors has allowed for self-neglect to be found where no such refusal is manifest (Braye et al, 2015;Preston-Shoot, 2020). Service refusal is returned to later in this paper, but as an aspect of self-neglect it is perhaps best seen as a secondary feature compared to the first order elements, neglect of self and/or environment.…”