Learning from safeguarding adult reviews on self-neglect: addressing the challenge of change

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 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 websites of Safeguarding Adults Boards (SABs). 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 an 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 SARs. 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 SARs 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 SARs by using the findings and recommendations systematically within a framework designed to embed change in policy and practice.

Mental health law under review: messages from English safeguarding adults reviews

“…The variety of SARs echoes that of their predecessors, Adult Serious Case Reviews (SCRs), owing to the range of circumstances reviewed (the types of abuse or neglect, the location, the timescale and the context). This is because once the decision to commission a SAR has been taken its terms of reference are locally determined by the SAB and, as Preston-Shoot (2018) suggested, a review needs an 'understanding of both local geography and the national legal, policy and financial climate within which it sits ' (p. 78).…”

Behind the cloak of competence: brain injury and mental capacity legislation

“…The difficulties associated with executive dysfunction and lack of insight mean that this perspective is sometimes unrealistic, and at points, a dangerous approach to apply in some cases of individuals with ABI (Preston-Shoot, 2018;Holloway and Fyson, 2016).…”

“…, self-neglect(Preston Shoot, 2018) and substance use(Weil et al, 2016) following ABI. A recent report by the All Party Parliamentary Group for ABI (APPG-ABI, 2018) highlighted some of these multiple risk factors, along with the need for ongoing community health and social care The participants in this study consisted of specialist BICMs across the UK.…”

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

“…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.…”