• Autonomy and protection in self-neglect work: the ethical complexity of decision-making

      Braye, Suzy; Orr, David; Preston-Shoot, Michael (Taylor & Francis, 2017-02-20)
      Self-neglect, in which an individual does not attend to their hygiene, health or home surroundings, is one of the most challenging aspects of adult social care practice. In England, its inclusion within the remit of adult safeguarding, as a result of changes in adult social care law introduced under the Care Act 2014, has thrown into relief the ethical dilemmas arising from tensions between respect for autonomy on the one hand and the exercise of a protective duty of care on the other hand. This paper draws on serious case reviews and safeguarding adult reviews in self-neglect cases, along with findings from adult safeguarding research, to propose that an appropriate balance between these two moral imperatives is not always achieved in self-neglect practice. It considers why autonomy appears to be privileged over other considerations, illustrating the complex interplay between law and ethics that gives autonomy pre-eminence. It then considers how a more nuanced, situated and relational approach to autonomy can enable practitioners to move away from dichotomous interpretations of the moral imperatives present in self-neglect work, and can support more nuanced understandings of the ethics of professional decision-making. Finally, it considers the personal and organisational implications of this enhanced ethical literacy.
    • The Care Act 2014: a new legal framework for safeguarding adults in civil society : Special edition editorial

      Penhale, Bridget; Brammer. Alison; Morgan, Pete; Kingston, Paul; Preston-Shoot, Michael (Emerald Group Publishing Limited, 2017-06-20)
    • Developing research and scholarship in law teaching for social work education

      Braye, Suzy; Preston-Shoot, Michael (Taylor and Francis Inc., 2016-03-31)
    • Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

      Preston-Shoot, Michael; University of Bedfordshire (Emerald, 2018-02-20)
      Abstract   Purpose – One purpose is to update the core data set of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to address the challenge of change, exploring the necessary components beyond an action plan to ensure that findings and recommendations are embedded in policy and practice.   Design/methodology/approach – Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. The repetitive nature of the findings prompts questions about how to embed policy and practice change, to ensure impactful use of learning from SARs. A framework for taking forward an action plan derived from SAR findings and recommendations is presented.   Findings – Familiar, even repetitive findings emerge once again from the thematic analysis. This level of analysis enables an understanding of both local geography and the national legal, policy and financial climate within which it sits. Such learning is valuable in itself, contributing to the evidence-base of what good practice with adults who self-neglect looks like. However, to avoid the accusation that lessons are not learned, something more than a straightforward action plan to implement the recommendations is necessary. A framework is conceptualised for a strategic and longer-term approach to embedding policy and practice change.   Research limitations/implications – There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here enables conclusions to be reached about issues to address locally and nationally to transform adult safeguarding policy and practice.   Practical implications – Answering the question “how to create sustainable change” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on change management and learning from the review process itself. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice.   Originality/value – The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of following up safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to embed change in policy and practice.     Keywords: Safeguarding adult reviews, change, self-neglect, action plans   Paper type: Research paper
    • Making any difference? conceptualising the impact of safeguarding adults boards

      Preston-Shoot, Michael; University of Bedfordshire (Emerald, 2019-11-25)
      Purpose Criticisms of the effectiveness of Local Safeguarding Children Boards (LSCBs) led to legislative reform in the shape of the Children and Social Work Act 2017. Given parallels between the mandates for LSCBs and Safeguarding Adults Boards (SABs), the onus is on SABs to demonstrate their effectiveness. The purpose of this paper is to explore how SABs might more effectively demonstrate their impact across the range of their mandated responsibilities. Design/methodology/approach The paper draws on definitions of impact from social work education, healthcare and from university research, exploring their relevance for capturing different types of data regarding the outcomes and impact of SAB activity. The paper also draws on frameworks for the process of capturing data and for implementing strategies designed to change practice and develop adult safeguarding services. Findings The paper argues that SABs have struggled to identify their impact and need to consider what types of impact they are seeking to demonstrate before choosing methods of seeking to capture that information. The paper also argues that SABs may have given insufficient thought to the process of change management, to the components needed to ensure that desired outcomes are embedded in procedural and practice change. Research limitations/implications This paper explores the challenges for SABs of identifying their impact and offers some theoretical frameworks that have defined different types of impact. The paper also draws on frameworks that identify the different components that are necessary for achieving change. This paper offers a contribution to theory building and is a response to the challenge of demonstrating the value that SABs add to adult safeguarding policy and practice. Practical implications A case study reviews the findings of the longitudinal service development and practice change initiative to embed making safeguarding personal in adult safeguarding. The findings of that initiative are mapped against the frameworks for identifying impact. Experience of implementing the initiative is mapped against the frameworks for effective implementation of change. Originality/value The paper presents frameworks for identifying the different types of outcomes and impact that SABs may achieve through their strategic business plans and for ensuring that the different components are present for the successful implementation and maintenance of change. The paper argues that the legal, policy and financial context within which SABs are located presents challenges as well as opportunities with respect to achieving and demonstrating impactful change. However, it also suggests that a more informed understanding of different types of impact may generate different approaches to data collection in order to capture what has been achieved.
    • Meaning in hoarding: perspectives of people who hoard on clutter, culture and agency

      Orr, David; Preston-Shoot, Michael; Braye, Suzy; University of Sussex; University of Bedfordshire (Taylor and Francis, 2017-12-12)
      Hoarding has become increasingly prominent in clinical practice and popular culture in recent years, giving rise to extensive research and commentary. Critical responses in the social sciences have criticised the cultural assumptions built in to the construct of ‘hoarding disorder’ and expressed fears that it may generate stigma outweighing its benefits; however, few of these studies have engaged directly with ‘hoarders’ themselves. This paper reports on in-depth, semi-structured interviews with ten individuals living in England, who received assessment and intervention for hoarding from Social Services. Their narratives drew on the cultural repertoire of values and discourses around waste and worth, the mediation of sociality and relationships through material objects, physical constraints on keeping order, and the role played by mental health. Analysing these perspectives anthropologically shows how dominant models of hoarding, such as the DSM-5 paradigm, potentially lend themselves to reductionist understandings that efface the meaning ‘hoarding’ may have and thereby deny agency to the person labelled as ‘hoarder’. More culturally informed analysis, by contrast, affords insights into the complex landscape of value, waste, social critique, emotion, interpersonal relationships and practical difficulties that may underlie hoarding cases, and points the way to more person-centred practice and analysis.
    • On (not) learning from self-neglect safeguarding adult reviews

      Preston-Shoot, Michael (Emerald Group Holdings Ltd., 2021-07-09)
      Purpose: The purpose of this paper is to update the core data set of self-neglect safeguarding adult reviews (SARs) and accompanying thematic analysis. It also explores whether lessons are being learned from the findings and recommendations of an increasing number of reviews on self-neglect cases. 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 domains used previously. The domains and the thematic analysis are grounded in the evidence-based model of good practice, reported in this journal previously. 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 and alcohol misuse are prominent. Some SABs are having to return to further cases of self-neglect to review, inviting scrutiny of what is (not) being learned from earlier findings and recommendations. Research limitations/implications: The national database of reviews commissioned by SABs remains incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. National Health Service Digital annual data sets do not enable the identification of reviews by types of abuse and neglect. However, the first national analysis of SARs has found self-neglect to be the most prominent type of abuse and/or neglect reviewed. Drawing together the findings 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 SARs. 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. Greater scrutiny is needed of the impact of the national legal, policy and financial context within which adult safeguarding is situated. Originality/value: The paper extends the thematic analysis of available reviews that focus on study with adults who self-neglect, further reinforcing the evidence base for practice. Propositions are explored, concerned with whether learning is being maximised from the process of case review.
    • On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

      Preston-Shoot, Michael (2017-02-15)
      Purpose: One purpose is to update the core data set of self-neglect serious case reviews and safeguarding adult reviews, and accompanying thematic analysis. A second purpose is to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards by exploring the degree to which the reviews scrutinised here can transform and improve the quality of adult safeguarding practice. Design/Methodology/approach: Further published reviews are added to the core data set from the web sites of Safeguarding Adults Boards and from contacts with SAB Independent Chairs and Business Managers. Thematic analysis is updated using the four domains employed previously. The findings are then further used to respond to the critique in the Wood Report of serious case reviews commissioned by Local Safeguarding Children Boards, with implications discussed for Safeguarding Adult Boards. Findings: Thematic analysis within and recommendations from reviews have tended to focus on the micro context, namely what takes place between individual practitioners, their teams and adults who self-neglect. This level of analysis enables an understanding of local geography. However, there are other wider systems that impact on and influence this work. If review findings and recommendations are to fully answer the question “why”, systemic analysis should appreciate the influence of national geography. Review findings and recommendations may also be used to contest the critique of reviews, namely that they fail to engage practitioners, are insufficiently systemic and of variable quality, and generate repetitive findings from which lessons are not learned. Research limitations/implications: There is still no national database of reviews commissioned by SABs so the data set reported here might be incomplete. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. This makes learning for service improvement challenging. Reading the reviews reported here against the strands in the critique of serious case reviews enables conclusions to be reached about their potential to transform adult safeguarding policy and practice. Practical implications: Answering the question “why” is a significant challenge for safeguarding adult reviews. Different approaches have been recommended, some rooted in systems theory. The critique of serious case reviews challenges those now engaged in safeguarding adult reviews to reflect on how transformational change can be achieved to improve the quality of adult safeguarding policy and practice. Social implications: Originality/value: The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also contributes new perspectives to the process of conducting safeguarding adult reviews by using the analysis of themes and recommendations within this data set to evaluate the critique that reviews are insufficiently systemic, fail to engage those involved in reviewed cases and in their repetitive conclusions demonstrate that lessons are not being learned.
    • Safeguarding adult reviews: informing and enriching policy and practice on self-neglect

      Preston-Shoot, Michael; (Emerald, 2020-04-25)
      Purpose – One purpose is to update the core dataset of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to explore the degree to which safeguarding adult reviews draw upon available research and learning from other completed reviews. Design/methodology/approach – Further published reviews are added to the core dataset, mainly drawn from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed 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 safeguarding adult reviews reported in this evolving dataset. 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 datasets do not enable identification of reviews by types of abuse and neglect. It is possible, therefore, that this dataset 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 central government that undermine any initiative to end rough sleeping. Originality/value – The 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. Policy-makers and practitioners have an approach to follow in this complex, challenging and demanding area of practice.   Keywords: Safeguarding adult reviews, evidence, self-neglect, research, multiple exclusion homelessness, alcohol misuse
    • Self-neglect and hoarding: a guide to safeguarding and support

      Preston-Shoot, Michael (Emerald Group Publishing Ltd., 2019-03-07)
    • Self-neglect and safeguarding adult reviews: towards a model of understanding facilitators and barriers to best practice

      Preston-Shoot, Michael (Emerald, 2019-08-01)
      Purpose – One purpose is to update the core dataset of self-neglect safeguarding adult reviews and accompanying thematic analysis. A second purpose is to draw together the learning available from this dataset of reviews to propose a model of good practice that can be used as the basis for subsequent safeguarding adult reviews. Design/methodology/approach – Further published reviews are added to the core dataset from the web sites of Safeguarding Adults Boards. Thematic analysis is updated using the four domains employed previously. A sufficient number of reviews have been done from which to construct an evidence-based model of good practice. A framework is presented with the proposition that this can be used as a proportional methodology for further safeguarding adult reviews where self-neglect is in focus. Findings – Familiar findings emerge from the thematic analysis. This level of analysis, constructed over time and across reviews, enables a framework to be developed that pulls together the findings into a model of good practice with individuals who self-neglect and for policies and procedures with which to support those practitioners involved in such cases. This framework can then be used as an evidence-based model with which to review new cases where safeguarding adult reviews are commissioned.   Research limitations/implications – The national database of reviews commissioned by SABs is incomplete and does not contain many of the safeguarding adult reviews reported in this evolving dataset. The Care Act 2014 does not require publication of reports but only a summary of findings and recommendations in SAB annual reports. It is possible, therefore, that this dataset is also incomplete. Drawing together the findings from the reviews nonetheless enables conclusions to be proposed about the components of effective practice, and effective policy and organisational arrangements for practice. Future reviews can then explore what enables such effective to be achieved and what barriers obstruct the realisation of effective practice. Practical implications – Answering the question “why” is a significant challenge for safeguarding adult reviews. A framework is presented here, drawn from research on safeguarding adult reviews featuring self-neglect, that enables those involved in reviews to explore the enablers and barriers with respect to an evidence-based model of effective practice. The framework introduces explicitly research and review evidence into the review process. Originality/value – The paper extends the thematic analysis of available reviews that focus on work with adults who self-neglect, further building on the evidence base for practice. The paper also proposes a new approach to safeguarding adult reviews by using the findings and recommendations systematically within a framework designed to answer “why” questions – what promotes and what obstructs effective practice.   Keywords: Safeguarding adult reviews, evidence, self-neglect, proportionality Paper type: Research paper
    • What is really wrong with serious case reviews?

      Preston-Shoot, Michael (John Wiley and Sons Ltd, 2017-07-20)
      Concern about the effectiveness of Serious Case Reviews for generating improvements in child protection in England led to proposals in the Wood review to replace the current system with rapid local learning inquiries and a national system of learning from significant incidents. This article challenges both the analysis in the Wood review and the proposals themselves. Whilst not uncritical of Serious Case Reviews, this article addresses five criticisms of the current review system. It explores how systemic the focus of reviews has been, and argues that findings and recommendations have become repetitive and lessons not fully appreciated because of an overly simplistic approach to change management. It suggests that there are methodologies that can effectively engage practitioners and managers in case reviews and that criticism of the review process itself can be addressed with refinements rather than wholesale change. The article concludes by questioning the assumptions upon which proposals for changing the current Serious Case Review are based. Copyright © 2017 John Wiley & Sons, Ltd. ‘Challenges both the analysis in the Wood review and the proposals themselves’. Key Practitioner Messages A systemic approach to Serious Case Reviews must engage legislative, social policy and societal systems as well as local policy and practice. A linear approach to learning and service development, often reflected in recommendations for training and policy refinements, is a less effective change management approach than engaging with single and multiagency contexts. Safeguarding children involves practice which is inherently social and relational, full of complexity and complicated truths; so too is the practice of reviewing cases. ‘Safeguarding children involves practice which is inherently social and relational, full of complexity and complicated truths’.