On self-neglect and safeguarding adult reviews: diminishing returns or adding value?

Abstract

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.