Professional responses when faced with third parties preventing - PowerPoint PPT Presentation

How to help when being hindered? Professional responses when faced with third parties preventing access to adults at risk at home Martin Stevens; Stephen Martineau; Caroline Norrie; Jill Manthorpe

Acknowledgement and Disclaimer • This presentation presents independent research funded by the Department of Health • The views expressed in this presentation are those of the authors and not necessarily those of the Department of Health

Introduction • What is hindering? • Helping or hindering research • Examples • Practice approaches • Legal contexts • Debates about a power of access • Dilemmas about using a power of access – Privacy – Vulnerability – Autonomy • Conclusion

What is hindering? Where social workers or other professionals face difficulties in accessing an adult at risk because of the actions of a third party, in the course of carrying out a safeguarding enquiry

Forms of hindering • Access to the premises is being denied by a third party, typically a family member, friend • Access to the premises is gained, but it is not possible to speak to the adult alone – because the third party insists on being present • The adult at risk themselves (whether or not unduly under the influence of the third party) is insisting that the third party be present • If the person is known NOT to have capacity then MCA applies

Helping or hindering in adult safeguarding: our investigation of practice • Phase 1 (complete) – Literature review – Secondary analysis of DH consultation on power of access and parliamentary debate (remember Care Bill?) • Phase 2 (now) – Survey of adult safeguarding managers • Phase 3 (now) – In-depth study in three Local Authorities – Interviews with safeguarding and social work managers, social workers and adults at risk

Example1: Aggressive offspring • History of reports of abuse of Mrs A, living with her son who was aggressive to care workers and declined medical and social care input on his mother’s behalf. • Evidence of duress (Kent & Medway Adult Protection Committee, SCR, 2005: 6). • ‘No attempt was made to remove her from the situation to assess her ability to make decisions when she was not under the duress.’ (p. 7). • ‘An assumption was made that Mrs A was better off staying in her own home despite extreme levels of neglect and considerable evidence of intimidation and unsuitability on the part of her carers’ (p. 10) (carers here meaning relatives). • Question – what would you have done?

Example 2: Gaining access • A safeguarding referral requiring a visit to an older woman with mental health problems • No answer, neighbours said the she had moved to a nursing home • Housing officer said she was still registered at the address • Housing officer and social worker about to enter the property (with the aid of a locksmith) in case of (possible) medical emergency • An unknown male confronted them and they couldn’t get in • The police agreed to gain access because of fears of a medical emergency • The man was detained under the Mental Health Act • The woman moved to nursing home care • Question – what would you have done ?

Practice approaches • Multi-agency and multi-disciplinary collaboration required with – Health professionals – Housing officers – Social care workers/agencies – Police – Fire service – Dept of Work and Pensions – Other services (e.g. gas engineers) – Other family members – Neighbours/former neighbours • Support from colleagues and managers • Training and development of negotiation skills

Power of access Legal differences in the UK Scotland - Adult Support and England – Care Act 2014, Protection (Scotland) Act 2007 • • Excluded a power of Powers of entry, removal and access banning on securing a court • Much consultation and order • debate Very limited use of orders to • Requires safeguarding date (Kerogen 2013) enquiries Wales - Social Services Northern Ireland and Well-being (Wales) Act • no legal power of access 2014 (s127): (but undecided) • power of access and to interview an adult at risk

Legal powers in England – do practitioners know about + use…? • High Court, under inherent jurisdiction, can grant non- molestation orders preventing a third party from impeding the enquiry. • Court of Protection may make a personal welfare order, effectively making the decision to allow access on the adult at risk’s behalf, if they lack capacity • Mental Health Act 1983 (s 135(1)) includes a power of access in support of a MHA assessment or with a view to making other care or treatment arrangements for the person • LAs and the Police can collaborate on issuing a Domestic Violence Protection Notice (s 24 Crime and Security Act 2010) - even if alleged victim does not agree. (re coercion and control: Helen Archer?)

Legal powers in England – do practitioners know about + use…? • High Court, under inherent jurisdiction, can grant non- molestation orders preventing a third party from impeding the enquiry. • Court of Protection may make a personal welfare order, effectively making the decision to allow access on the adult at risk’s behalf, if they lack capacity • Mental Health Act 1983 (s 135(1)) includes a power of access in support of a MHA assessment or with a view to making other care or treatment arrangements for the person • LAs and the Police can collaborate on issuing a Domestic Violence Protection Notice (s 24 Crime and Security Act 2010) - even if alleged victim does not agree. (re coercion and control: Helen Archer?)

Mental Health Act 1983 – do practitioners know about and use? • S115 – An approved mental health professional (AMHP) can enter a premises if it is believed a person with mental health problems is not being given proper care – No forced entry, but obstruction without reasonable cause is an offence • S135(1) 307 in 2013/4 (NHS Digital figures) – A magistrate may issue a warrant authorising a police officer to enter premises, – Warrants only issued if there is reasonable belief that the person suffering mental disorder has been ill-treated or neglected – Force is allowed if necessary – It is possible to remove a person to a place of safety for a mental health assessment or arrangements for care SCIE, 2014: p14

Arguments for and against a power of access when person has decision-making capacity • Frequency of need for • Can exacerbate problems power of access (DH • Need more than just consultation AEA FOI) power of access • Impact of duress (e.g. • Could interrupt domestic violence) relationships with • Can be useful context to professionals negotiations • Could encourage • Can short-circuit delays professionals to take (which can prolong shortcuts experience of abuse)

Power of access - key concepts Vulnerability created by individual characteristics VS Vulnerability created by impairment, power relationships and social context Hard public/private boundary VS Public/private blurred, relative terms Autonomous individuals VS Autonomy mediated by social relationship and social structures

Conclusion • Distinction between approach with previously unknown and known adults at risk – No knowledge of capacity or consent • Tensions between practice development and power of access • Importance of socially mediated conceptions of privacy, vulnerability and autonomy – approaches to intervention, – decisions about overcoming hindering – Interpreting consent or lack of consent • Next stage will explore evidence about prevalence, practice and views on power of access

Thank you for listening! Research team: • Martin Stevens – martin.stevens@kcl.ac.uk • Stephen Martineau – stephen.martineau@kcl.ac.uk • Caroline Norrie – caroline.norrie@kcl.ac.uk • Jill Manthorpe – jill.manthorpe@kcl.ac.uk Helping or hindering in adult social care Project website: http://www.kcl.ac.uk/sspp/policy- institute/scwru/res/capacity/helping-or-hindering.aspx