“John” – A Safeguarding Adults Review • The Care Act 2014 made Safeguarding Adults Reviews a statutory requirement (section 44) in cases where: – an adult [with care and support needs] in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult. – if an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect.
Background • John – 56 year old man (at the time), lived in a privately rented 2 nd floor flat with two of his adult sons • Had mobility problems but no issues about his mental capacity • History of intermittent engagement with GP
Background • June 2015 - Had a period of ill health, was admitted to hospital. Went home with some needs for care and support • Social worker and Occupational Therapist made frequent attempts to visit/contact John • Eventually gained access and arranged Reablement service (short term service designed to help people regain their independence) • Reablement workers were unable to gain access to John • Not able to physically access John’s flat because on the 2 nd floor • Workers were told over the phone by sons that he was away at a funeral
Background • After a number of failed attempts, Reablement closed the case and sent a letter to John advising him what to do if support required • November 2015 – sons call 999 saying John had had a suspected heart attack • Paramedics arrived to find John “rotting in his chair”
Background • Full depth pressure sores to his groin area which were infected with maggots • Chair and surrounding area covered in faeces and urine • Living conditions in the property described as “squalid” • Fire Service had to assist in getting John out of the building by removing a window
Outcome • John admitted to hospital, not expected to survive the night • Sons arrested for wilful neglect under section 44 of the Mental Capacity Act but this did not proceed to a charge • Against all expectations, John survived and is currently continuing with rehabilitation in preparation to return home.
John’s views • John took part in the review and described how he had “just given up” • He didn’t hold any professionals responsible for what had happened to him • Nevertheless, the review has uncovered some learning for the multi agency safeguarding partnership
Learning • The review found that none of the professionals involved had “done anything wrong”, however there were some learning points: • Raising awareness amongst private landlords re hoarding and self-neglect, on the basis that safeguarding is everyone’s business • Reviewing “out of contact” protocols for health and social care (balance needed) • Reviewing case closure decision points
Challenges • This case was complex because it was a mixture of self- neglect (by John of himself) and neglect (of John by his sons) • How should professionals respond when a person with capacity refuses all help and puts himself at serious risk as a result? • The Mental Capacity Act 2005 enshrines the right of adults with capacity to make “unwise decisions” • Importance of human rights (Article 8 of the ECHR) • BUT also duty of care. Where is the boundary?
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