28 june 2010 decision making conference safeguarding, choice, accountability, risk taking…. social...
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28 June 2010 Decision Making Conference
Safeguarding, choice , accountability, risk taking….Social work decision making
in context
Jill Manthorpe
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28 June 2010 Decision Making Conference
Social Work Decisions
• What many people want to them to do and policy makers want to encourage
• Essence of professionalism?
• Context of protocols, pathways and evidence
• The future looks…?
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28 June 2010 Decision Making Conference
If only..
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28 June 2010 Decision Making Conference
Government decisions - context• Commission on long-term
care, to report within a year. • Break down barriers
between health and social care funding to incentivise preventative action.
• Extend the roll-out of personal budgets to give people and their carers more control and purchasing power.
• Use direct payments to carers and better community-based provision to improve access to respite care.
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28 June 2010 Decision Making Conference
safeguarding
Larger evidence base for decision making
• Prevalence & incidence, data reporting
• When things go wrong eg serious case reviews
• Case law from Mental Capacity Act 2005, eg offences of wilful neglect/mistreatment
• Still legal uncertainties eg ISA under review
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28 June 2010 Decision Making Conference
Practice on the ground
• Bridging support plans & safeguarding plans
• Conditions of personal budgets – prevention (eg checks of PAs), recipients are ‘vulnerable adults’
• Monitoring & reviewing (Recording)• Looking to Scotland for evidence of
intervention effects• Linking up, DV, NHS, hate crime
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28 June 2010 Decision Making Conference
choice
• Major roll out of personal budgets (some blended funding) for all groups (self-directed support)
• Money on more direct employees (PAs) but large agency expenditure (need changes)
• Day centre closures• Evidence positive – in the
main
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28 June 2010 Decision Making Conference
Practice on the ground
• Support plan processes…• Level of monitoring and
review• Lite touch?• Duty of care? (IBSEN)• More proxies (but little
advance planning – Evidem)
• Recording choices eg paper, video…
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28 June 2010 Decision Making Conference
2 gov decisions on Social Action: accountability changes
• Create & expand mutuals, co-operatives, charities & social enterprises, ensure greater involvement in running of public services.
• Public sector workers to get a right to form employee-owned co-operatives & bid to take over the services they deliver.
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28 June 2010 Decision Making Conference
Practice on the ground
• Newish relationships of accountability
• Commissioning requiring evidence, confidence and cost-effectiveness
• High use of language of productivity
• More fissures in working relationships leading to greater centralisation
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28 June 2010 Decision Making Conference
Risk
• High level interest in risk enablement and rights, ‘nothing ventured, nothing gained’
• Not so many risk policies, more embedded
• Focus on assembling agreement
• Risk to self freed up but risk to others….
• Dangerous people, perpetrators… left aside.
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28 June 2010 Decision Making Conference
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28 June 2010 Decision Making Conference
Practice on the ground
• High levels of need among state funded users: different sorts of risk; eg end of life
• Patient safety – managing at home
• Calls to manage crises; rapid decision making (advance and proxy)
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28 June 2010 Decision Making Conference
Decision making?
• Huge ethical questions (so nothing new)
• Evidence base from recording v system requirements
• Skills at risk conversations, conflict management, best interests…
• End thought - More decision shaping?
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28 June 2010 Decision Making Conference
resources
• Evidem.org.uk
• SCWRU - kcl.ac.uk
• NIHR National School for Social Care Research