Transcript Safeguarding Adults Department of Health Research

The Governance of
Adult Safeguarding:
Findings from Research
Suzy Braye, University of Sussex
Michael Preston-Shoot, University of Bedfordshire
Local Government Association: February 2013
Our overall research aim
To identify good practice in the governance of adult
safeguarding through review of Safeguarding Adults Boards
• Governance: how an organisation or activity is directed and controlled;
how responsibility and accountability are exercised
• Structures and coordinating mechanisms
• Management, power and authority
• Frameworks and boundaries for decision-making
To identify ways in which boards practise empowerment
The governance challenge in
adult safeguarding
The nature of the mandate
The multi –agency involvement
The diversity of accountability routes
Debates about the nature & scope of the task
Sources of data in the research
1. Literature
• Database searches:
• 3163 sources/48 included
2. Workshops
• London/Manchester
• 31/44 attendees
3. Key informants
• Individual overview (5)
• Practitioner focus group (1)
4. Regional
project work
5. Survey of SAB
documents
• Boards, chairing & governance
• Participation of users and carers
• 47 authorities, 203 documents
• Submissions, websites, CQC
CQC 2009 scores on outcome 7: N=153 Total sampled = 47 (31%)
All local authorities
Our sample
Excellently
12
8%
12
25%
Well
90
59%
21
45%
Adequately
45
29%
13
28%
Poorly
2
1%
0
0%
Not rated
4
3%
1
2%
153
100%
47
100%
Key findings on governance
arrangements
3. Structures
and
membership
patterns
4. Key
functions
2. Definition
and scope of
their activity
1. Purpose
and mission
5. Rules of
engagement
SAB
6.
Accountabilities
1. What are boards for? What are
their purpose and mission?
• Tension between strategic and operational
purposes
– The balance between
strategic & operational
focus impacts on structure
– Structure influences
strategic and
operational capacity
Strategic
leadership
Operational
quality
Statements of shared principle
Recognition of diversity; commitment to equality and fair access
Recognition of and respect for human rights and dignity
Promotion of independence and autonomy, choice and control
Commitment to empowerment
Capacity to make decisions, or best interests interventions
Proportionality in containing risk
Confidentiality
Duty of care - a right to protection
Commitment to participation
2. The scope of safeguarding
• The way boards express their
mission is related to the
question of definition
and scope of
safeguarding; they
work more widely
than definitions
imply
Users of services
Vulnerable adults
Community
population
Choices of focus for engagement
Individual
focus
Preventive
work
Reactive
work
Whole
community
focus
Modelling the scope
Community engagement
Community
awareness
raising
Specific
initiatives to
address
identified harm
to groups
Preventive
Reactive
Education/risk
management
initiatives
Investigation
and protection
planning
Individual engagement
3. Structures and membership
Wide variety in size: 10 – 30+
Tensions between seniority and inclusion
Trend for restructuring and multi-layering
Sub-groups for operational efficiency: training; policies/procedures; QA
Specification of commitment and contribution is common
Expectations of member agencies
Designate a lead officer
Ensure implementation of No Secrets, and Board expectations
Provide monitoring information and an annual report to the Board
Contribute to strategic direction of the board
Provide clear operational guidance for staff and appropriate training
Ensure robust procedures for:
•
•
•
•
•
•
Recruitment and selection of staff
Risk assessment
Embedding safeguarding in care plans
Reporting and recording
Whistleblowing
Responding to allegations against staff
Expectations of individual members
Communication link between board and agency
Monitoring compliance of the member agency
Providing feedback to the board
Ensuring compliance with AQ requirements
Participating in and leading sub-groups
Facilitating information sharing
Acting as a safeguarding voice
Horizontal and vertical
differentiation
Safeguarding Adults Board
[Strategic function]
Safeguarding Adults Group
[Operational function]
Safeguarding Adults Board
SubGroup 1
SubGroup 2
SubGroup 3
SubGroup 4
Range of sub-groups
Workforce
development
Serious case
reviews
Policy &
procedures
Short life task &
finish
Quality assurance
Locality based
Communications & groups
publicity
Service users &
carers
Practice
development
Practitioner liaison
Wider stakeholder
networks
Special interest
groups
Structural links with
external stakeholders
Accountability links to
partnerships &
committees
Links with other
safeguarding
boards
Links with other
SAB
coordinating
partnerships
Links with those who
need to know
Policies &
procedures
Review &
improve
practice
Member
agency
compliance
Performance
management
and QA
Training
strategy
4. Board
functions
Strategic
planning
Interagency
relationships
Public &
professional
awareness
Mechanisms for quality assurance
Regular reports from
member agencies
Audit of compliance with
procedures
Commissioning and
contracting
Audit and inspection
Improvement action
plans
Evaluation of training
Case file audit
Self evaluation by caseholders
Monitoring of activity
statistics
Serious case review
action plans
Long term quality
improvement work
External peer review
5. Rules of engagement
Chairing
Rules of engagement
20%/50% independent
Frequency of meetings
Role descriptors
Diverse reporting
Attendance & Quoracy
Pros & cons
Divided opinions
Decision-making
mandate: not executive
Challenge/Accountability
Ownership/Responsibility
Voting protocols
Role of Chair
Role of the chair
The role of the chair is to work:
• On board mission, strategy and planning
• On the conduct of the board’s business
• In the interagency arena
• On external accountabilities and relationships
• On the public face of the board’s activities
• In the regional and national arenas
Leadership, Coordination, Support, Challenge
Independent chairing
Perceived benefits
Perceived risks
Greater degree of challenge to the
safeguarding system
Distancing of the LA from its lead role
and reduction of senior LA
involvement
Exercise responsibilities without
agency self-interest
Abdication of responsibility by key
statutory agencies
Fairness in holding agencies to
account
Lack of authority to resolve
interagency politics
Mediation of interagency power
relations
Lack of insider knowledge of local
politics
External credibility in the public
perception
Cost
Essentially, transparency,
challenge and scrutiny
Essentially ownership, authority
and resources
Developments on independent
chair appointment processes
Advertising and formal applications process
Job description
• Main purpose/strategic role
• Accountabilities
• Main activities and responsibilities
Person specification
• Education/training/qualifications
• Relevant knowledge
• Relevant experience
• Skills
• Personal qualities
Accountability of the
independent chair
Seldom made explicit, and is complex
In reporting terms, may be to:
• Director of Adult Social Care
• Chief Executive of the Council
• Executive Board of the safeguarding partnership
Each of these lines of accountability has pros and cons, and
may compromise independence, or perceived independence
Resources
Securing resources for the work of the board is a key challenge
Resource position of LSCBs is believed to be clearer and more secure
Lack of national performance indicator perceived as a barrier to securing LSP resources
Boards tend not to have dedicated budgets (though some do)
Costs often shared between the lead statutory partners; default responsibility falls to the LA
Contributions from other partners may be in kind
Business planning models more common as boards seek to make robust a case
6. Accountabilities
Of members to
the board
• Parallel to processes in member agencies
• Periodic reporting mechanisms
Self regulation
of the board
• Standards for evaluating Board performance
• Statements of IC’s responsibilities
Of the board to
external bodies
• Diversity and complexity of reporting
• Multi-agency engagement
• Complexity of stakeholder network
Organisational structure shown with permission from the named authority
Accountability matrix rather than hierarchy
• Diverse forms of accountability owed to multiple
stakeholders
Different forms of accountability
• Political accountability to the body from which the
board draws its power/mandate, for the ways in which
it exercises that power, and the outcomes it achieves
• Explanatory accountability, to those to whom ones
actions must be explained or justified
• Responsive accountability, owed to those whose views
must be taken into account
Key findings on empowerment
“Work in progress”: diverse mechanisms
Principles & values: human rights, choice & control
Participation in own safeguarding
Post hoc feedback and evaluation
Participation in board functions
Community engagement: conferences, publicity, events
G vE and others [2010]
The mandate for involvement in one’s own
safeguarding is further strengthened by
judgement in G v E and others (EWHC 621
(Fam)(26 March 2010).
The court was very critical of the
safeguarding procedures adopted by the
local authority, and in particular of key
meetings held without the involvement of
the individual who was the subject of the
safeguarding concern, and his carer.
Facilitators of empowerment
The vision and will to make it happen
Support and leadership from senior staff
Support and leadership from Forum participants
Openness and honesty of communication
Commitment to a rights based approach
Commitment from the multi-agency board
Creativity and imagination in ways of communicating
Resources - mainly time and energy rather than money
So what does good practice in
governance look like?
Membership
Functions
Structures
Goals and
purpose
Checks
and
balances
Accountabilities
Good governance 1: Goals and purposes
Definition of the scope of the activity
Strong statement of principles
Clarity of goals & explicit multiagency commitment
Innovation/strategic leadership
Good governance 2: Structures
Clear divisions of responsibility – horizontal differentiation
Mechanisms for communication between layers – vertical coordination
Clear focus for specific functions - vertical differentiation
Explicit linking between functions – horizontal coordination
Safeguarding Adults Board
Safeguarding Adults
Sub-Group 1
Sub-Group 2
Operational Group
Sub-Group 3
Sub-Group 4
Good governance 3: Membership
Rationale for inclusion
Clear understanding of roles & explicit commitments
Stakeholder engagement
Chairing arrangements and meeting protocols
Clarity on contribution of resources
Good governance 4: Functions
Strategic planning & operational oversight
Audit, performance management and QA
A strong developmental/improvement agenda
Boundary management, cross agency
Good governance 5: Accountabilities
Standards for board performance
Clarity about decision-making authority
Clarity about accountabilities owed
Links with other partnerships
Explicit mechanisms for empowerment
Mechanisms for representation & redress
The Future?
• Draft Care and Support Bill
• Placing LSABs on a statutory footing
– Power to generate resources
– Capacity to conduct announced and unannounced audits
• Will newly configured and resourced LSABs help to
hold statutory and third sector organisations
accountable for the care they provide?
– Avoiding another Winterbourne or Mid Staffordshire?
Contact details
• Suzy Braye
Professor of Social Work
University of Sussex
[email protected]
• Michael Preston-Shoot
Dean, Faculty of Health & Social Sciences
University of Bedfordshire
[email protected]