Serious case review findings on the challenges of self-neglect: indicators for good practice

Abstract

Purpose – The purpose of this paper is to analyse in detail the findings from 40 serious case reviews (SCRs) involving adults who self-neglect, and to consider the commissioning and reporting of such inquiries in the context of accountability that also involves the Coroner and the Local Government Ombudsman. Design/methodology/approach – This study comprised a cross-case analysis of 32 SCRs, using a four-layer design of the adult and their living context, the team around the adult, the organisations around the team, and the Local Safeguarding Board around the organisations. Findings – Available reports tend towards description of events rather than appraisal of what influenced practice. They highlight the challenges in cases of self-neglect practice, including person-centred approaches, capacity assessment and securing engagement. Familiar themes emerge when the spotlight turns to professional and organisational networks, namely information-sharing, supervision, recording and compliance with procedures and legal rules. Some Local Safeguarding Adults Boards found the process of conducting and then using serious case reviews for service improvement challenging. Research limitations/implications – The cross-case approach to thematic analysis focuses on reports into situations where outcomes of professional and organisational intervention had been disappointing. Nonetheless, the themes derived from this analysis are similar to other research findings on what represents best practice when working with cases involving self-neglect. Practical implications – The paper identifies learning for the effective commissioning and conduct of SCRs, and for service improvement with respect to practice with adults who self-neglect. Originality/value – The paper offers further detailed analysis of a large sample of SCRs that builds the evidence-base for effective practice with adults who self-neglect and for efficient management of process of commissioning and conducting SCRs.

Autonomy and Protection in Self-neglect Work: The Ethical Complexity of Decision-making

“…Self-neglect thus falls within the statutory remit of safeguarding, which places a duty on local authorities to investigate where adults with care and support needs are experiencing (or are at risk of) abuse and neglect and as a result of their needs are unable to protect themselves. Yet the challenges experienced by health and social care professionals when working with people who self-neglect are well documented, both in research and in individual case reviews, which are required by the Care Act when an adult who experiences abuse or neglect dies or sustains serious injury and there is concern about how agencies worked together (Galpin, 2010;Day et al, 2012;Braye et al, 2014;Braye et al, 2015). The question at the heart of the challenge, and which is addressed in this paper, is how services can respect individual autonomy yet at the same time exercise their duty of protection in the context of significant risks and refusal to engage.…”

“…We draw first on previous research (Braye et al 2015;Preston-Shoot, 2016) into reviews of individual cases (previously known as serious case reviews (SCRs) and now renamed safeguarding adult reviews (SARs) since implementation of the Care Act 2014. A systematic search of all Safeguarding Adult Boards (SAB) websites in England was undertaken.…”

“…A systematic search of all Safeguarding Adult Boards (SAB) websites in England was undertaken. The analytical method by which themes were derived from these reviews of the outcomes of practice has been described elsewhere (Braye et al 2015). In the context of this paper the focus is on those reviews that comment on the ethical dilemmas of practice.…”

Towards explanations for the findings of serious case reviews: understanding what happens in self-neglect work

“…Inquiries by Coroners and the Ombudsman have pointed out both inadequacies and contradictions in the legal rules (Braye et al, 2015b). Researchers have commented on the powerful ethical force of the statutory presumption of capacity, with practitioners consequently reluctant to question people's choices and uncertain how to balance the protection of a capacitated adult with individual autonomy (Flynn, 2007;Galpin, 2010;Keywood, 2010).…”

“…As before (Braye et al, 2015b) four domains are used here to explore in detail the themes that were apparent on reading the SCRs.…”