By Bruno Ornelas, Head of Service, VOICES

Adult safeguarding has seen a considerable shift in how it responds to adults at risk of abuse and neglect. Over the last decade legislative reform has led to considerable changes in how adult safeguarding and community care is arranged and understood.  For example, placing self-neglect within adult safeguarding fundamentally re-frames notions of adult protection duties, which prior to the Care Act 2014 had focused on harm caused by a third party; this was a position maintained by governmental guidance No Secrets (DH, 2000).

The Care Act 2014 also places the work overseen by local Safeguarding Adult Boards (SABs) on a statutory footing. Local authorities are now required to establish SABs to provide strategic oversight and to carry out its duty under the Care Act 2014. The specific hosting components of Schedule 2 (Care Act 2014) require Safeguarding Boards to: Publish and implement a strategic plan, publish an annual report and include reporting on findings from Safeguarding Adults Reviews (SARs), and to decide and provide reasons for when a SAR is, or is not, commissioned. (DH, 2016).

Despite these legislative developments, reports by the Bureau of Investigative Journalism and The Guardian highlight that SARs, where rough sleeping contributed to serious harm or reduced mortality, are rarely considered and commissioned. In the first study of its kind, VOICES had the opportunity to collaborate on research with Kings College London (KCL) to conduct a thematic analysis of existing SARs where rough sleeping contributed to reduced mortality or harm. Commissioned by the Department of Health, KCL led on the review and identified five broad themes:

1.       Co-operation, co-ordination and leadership (within the local authority and inter-authority co-operation)

2.       Being assessed (Housing Act 1996, Care Act, Mental Capacity Act)

3.       Suitable accommodation provision

4.       Hospital Discharge (poor discharge arrangements including care planning and coordination)

5.       Safeguarding (missed opportunities, self-neglect, making safeguarding personal, lack of professional curiosity, engagement, normalising risk, practitioner attitudes)

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SARs have an important part to play in policy development and systems change work in particular when there is an appreciation for the philosophical uncertainties that often arise from abuse and self-neglect than impact people experiencing multiple disadvantages linked to rough sleeping.  SARs have the potential to bring renewed accountability in relation to how multi-disciplinary teams work which may push for better integration across disciplines. This should include taking a closer look at custom and practice linked to values and beliefs, representations surrounding an individual’s capacity to make cognizant and competent choices and the influence these notions have on individuals and multi-agency systems.