The Knowledge Of Working With Vulnerable Adults Social Work Essay

Published Date: 23 Mar 2015

Within my assignment I will demonstrate my knowledge and understanding of safeguarding and critically explore safeguarding and what this means in the context of working in social care today, and the impact on my role as a newly qualified social worker. I will refer to adults with a learning disability in order to examine some of the issues and dilemmas that may occur. I will examine these areas within Thompsons PCS model (Thompson,1997) in order to reflect the intricacies and dilemmas with safeguarding adults.

Although anti discriminatory practice and anti oppressive practice are often interchanged with each other, Braye and Preston- Shoot(2005) maintain that they are very different. Anti discriminatory practice challenges discrimination within a very clearly defined framework whereas anti oppressive practice is about challenging values and beliefs. According to Thompson(1997) oppression can be examined using a model that considers (P) personal (C) cultural and (S) structural, the PCS Model. This model examines oppression on 3 levels. Personal is regarding and individual, their views, beliefs and actions. Cultural is the community level and structural is regarding the socio-political and institutional level. Only by understanding power and control can we practice in anti oppressive way, by challenging the power structures on all levels personal, cultural and structural.

People with learning disabilities have been a marginalised and oppressed group who have constantly struggled for their voices to be heard. Pam Evans cited by Swain et al(1993)identified assumptions made by non disabled people which included ideas that disabled people "want to achieve normal behaviour"; "resent able bodied people" and "never give up hope of a cure"(p.102).These assumptions are based on personal beliefs, borne out of cultural ideas of disability and structurally based philosophies of disability. The medical model of disability has been the predominant model in understanding disability(Swain el al,2003) from incarceration in hospitals and in some respects to services provision today. These responses have only served to re-inforce beliefs of disability such as those Pam Evans discovered. Although there was growing concern amongst civil rights movements regarding the medical model, Mike Oliver(1983) coined the phrase social model of disability. This social model of disability led to a shift in thinking about disabilities, that it was societal attitudes that were disabling rather than matters relating to the individual capabilities(Swain et al,1993). Although the social model of disability is the accepted model particularly within social welfare the doctrine of the medical model is not easy to unlearn. Although on a structural level there have been changes in legislation and policy such as Disability Discrimination Act 1995; Community Care (Direct Payments) Act 1996; Human Rights Act 1998; Mental Capacity Act 2005 and Valuing People 2001.Putting these changes in to practice from a personal and cultural perspective is more complex and this is typified in safeguarding.

. The term "vulnerable" has become synonymous with safeguarding. The immediate connotations when using the word "vulnerable" are stark. It immediately suggests weakness, helplessness and the person is at danger or at risk(Williams,2006). Crawford and Walker(2008) also recognised that there are significant risk factors when exploring vulnerability - the person is usually socially isolated, the person has previously been at risk of abuse and requires practical and / or emotional support. In the policy document No Secrets(DOH,2000) there was an initial recognition that some groups of adults were more likely to experience abuse and the term "vulnerable adult" was used as a definition of the groups potentially at greater risk.

Although there has been a shift to try to better understand the term "vulnerable adult" The Association of Directors of Social Care (2005) wrote in their policy framework document "they include adults with physical, sensory and mental impairments and learning disabilities..."(p.4) they continue.." when an adult in this group is experiencing abuse or neglect this will have a significant impact on their independence, health and wellbeing."(ADSS,2005,p.4).Yet I would argue anyone who experiences abuse or neglect, there would be significant impact on their health and well being and we should be striving to ensure all individual's safety. Martin(REFERENCE) also suggests that this link with safeguarding and vulnerability and illustrates this well. Often the link with safeguarding and vulnerable adults, is with specific groups of individuals - people with disabilities, older adults etc. increasing the stereotypical view of groups and so increasing discrimination and oppression(Williams,2006). Whilst the shift in policy documents is from protection to safeguarding vulnerability and its use is still debated.

In October 2008 the Government launched a review of the No Secrets guidance. This guidance originally came in, in an attempt to "give guidance to local agencies who have a responsibility to investigate and take action when a vulnerable adult is believed to be suffering abuse."(DOH,2000 p.7) It was intended to utilise good practice locally and nationally and offer a structure for the improvement of inter-agency policies, procedures and joint protocols. There are a range of barriers which impede good interagency working - Different core functions; cultures and practices between agencies; lack of clarity in lines of authority and decision-making; historical or current rivalries between agencies; different and conflicting social policy or legislation; lack of clarity about why agencies are involved and poor communication (Edwards et al, 2009).The repeated missed opportunities of inter agency working have resulted in disastrous outcomes for many individuals, despite the repeated findings of investigations(Flynn,2007;Bichard Report 2004;Lord Laming Report, 2009), inter agency working has been a constant blight in social welfare. As a practitioner I acutely aware of the challenges and the importance of partnership working, as well as the devastating impact resulting in deaths and shattered lives if we fail in this arena.

Some consider that there is a lack of legislation which directly covers safeguarding adults(Action on Elder Abuse,2009 and The Law Society,2009). In an article in Community Care (July,2009) Despite legislative reform being highlighted as a key area by respondents of the No Secrets review the Government have failed to implement specific legislation regarding safeguarding and the protection of adults. Some would argue there is a growing need for specific legislation regarding safeguarding. The recent report from Action on Elder Abuse(2009) to the consultation review of No Secrets(DOH,2000) there was an overwhelming request for legislation specific to safeguarding. Whilst others feel there is a lesser need than in children's legislation, which is specific about statutory duties and responsibilities of local authorities regarding safeguarding, another arm of the debate is there have been missed opportunities to link and use current legislation effectively(Pritchard,2008).

Legislative reform has universally followed from child protection and child safeguarding. In recent years, the government has taken steps to progressively tighten up the law in this area. The law in this area has often been introduced as a reaction to events and as a result is viewed by some to lack coherence(The Law Society, 2009). Recent changes have occurred in order to address some of the gaps perceived. The recent introduction of the Safeguarding Vulnerable Groups Act 2006 is an example of legislative change that was a direct result of the murders of Holly Wells and Jessica Chapman. The perpetrator, Ian Huntley had a history of contact with police but a catalogue of system wide communication errors and intelligence sharing errors were identified (Bichard,2004).But as with any system, it is only as good as those who use it, and often investigations find it is not the procedure or system but those who use it who are at fault. Sir Michael Bichard(2004) who headed the inquiry into the Soham murders stated there were flaws in the system for creating records as well as the guidance and training offered to those inputting and deleting information. Cornwall hit the headlines with the case of Steven Hoskin who was murdered in 2006.Flynn(2008) described systemic failures of agencies to recognise Steven Hoskin as vulnerable adult and share information for a co-ordinated approach of intervention.

In 2006 the government introduced the Safeguarding Vulnerable Groups Act 2006, which laid the foundation for the new Independent Safeguarding Authority, which has enabled the introduction of the vetting and barring scheme(H.M Government, 2006). The new vetting and barring scheme may to some extent be rendered ineffective as a result of the recent expansion of the European Union. Unrestricted working rights means a more mobile workforce and for some there are no formal procedures to require notification or registration of matters occurring in individuals home countries, that would have required notification to the Independent Safeguarding Authority had they occurred in the UK(Soret,2009).

In Scotland in 2007 specific legislation was introduced but this is still yet to be proved as improving safeguarding. Some professionals in Scotland believe there are still those dilemmas about rights and risks(REFERENCE) that some in England feel would be addressed with legislation. Interestingly it isn't just the professionals that feel the legislative changes don't go far enough. Advocacy groups such as Action on Elder Abuse and The National Autistic Society are just two of the organisations calling for tighter legislation on safeguarding. Action on Elder Abuse refers to some key issues regarding the No Secrets review regarding timescales; sharing information; key responsibilities and recognition of some of the complexities and circumstances surrounding abuse and call for a system which recognised these complexities(REFERENCE).

The newest dimension to safeguarding adults has been the eruption of personalisation. Duffy and Gillespie(2009) maintain that personalisation will make people safer. They maintain by strengthening citizenship and reducing social isolation will reduce risk and by empowering people to take control of their lives enables people to increase their resilience. Personalisation also challenges the cultural and structural concepts, particularly misconceptions of groups of individuals such as people with learning disabilities. Rather than maintaining the medical model of disability where it is perceived a person with a learning disability has difficulties simply because of their cognitive functioning, it highlights the social model of disability where a person's needs are not well catered for by societal structures(William, 2006).

This is probably the area which is currently leading to much debate and discussion particularly in the area of support for adults with learning disabilities as this is where the ethos of self directed support was born(REFERENCE).There are numerous arguments currently being circulated regarding the perceived risks of individuals and families being in control of their service provision in whatever format they choose(REFERENCE) and the decisions people can make regarding checking and therefore reducing the influence and control from statutory servicers.

I believe that the current tension is borne out of a misrepresentation of personalisation. Fitzgerald(2009) cited in Community Care magazine(2009) that personalisation has been viewed simply as "cash for care", rather than from the principle of seeking to ensure that an individual is in control of their life, as much as anyone can be. This coupled with the view that safeguarding and personalisation are opposing viewpoints is causing the dilemmas of personalisation. The narrow focus on 'cash for care' models is preventing the much wider debate about citizenship rights in the context of social and health care. Consequently, we must start from the premise that any support package or service must be as safe as possible, constructed with a full understanding of the nature of abuse, its dynamics, and the factors that may give rise to it. That is not the same as removing risk, because to do so would make living impossible.

If we are committed to safeguarding then risk reduction is vital. We must refrain from individualistic concepts of risk through the notion of 'vulnerability'. Instead of focusing solely on the protection of 'vulnerable' individuals, we must see beyond 'vulnerability' and aim to eliminate conditions that create risk. Interventions should be enabling and widespread, targeting social processes that are responsible for the creation of risk(REFERENCE). The focus on impairment as the main risk factor to abuse entails elements of a medical model approach to disability. This is too narrow a focus, but an ecological approach, takes into account both the individual and social causes of risk and of the interactions between them. Social model researchers and practitioners suggest that the safest way of protecting people with learning disabilities is to enable them to increase their self determination(McCarthy, 1999; McCarthy and Thompson, 1996; Hingsburger,1995). Self determination is shaped through social interactions and citizenship providing a tool for identifying areas for effective risk prevention interventions. We need to be clear that rights to choice and control are not irreconcilable with a right to protection. After all each citizen has rights, choices and control and equally have recourse within the law should protection be required. It is perilous to imply that safeguarding and personalisation are opposed or in conflict. People cannot organise their own care and support, or accept such care and support, if they do not feel safe and consequently a personalisation approach must have safeguarding as an integral part of its operation. Not because a person is classified as vulnerable, or because a person requires community care services, or has a learning disability but because ethically and morally for the sake of social justice it is the right thing to do.