Risk Safeguarding and Personal Budgets Do personal budgets

Risk, Safeguarding and Personal Budgets: Do personal budgets increase the risk of abuse? Staff and service user experiences Martin Stevens, Jill Manthorpe and Kritika Samsi Shereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Acknowledgements This project was funded by the National Institute for Health Research (NIHR) School for Social Care Research (SSCR) (project number - T 976/EM/KCL 2). The views expressed in this presentation are those of the authors, not necessarily those of the Department of Health, the NHS or the NIHR. Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Plan Qualitative element Objectives and methods Summary of findings from staff and from service user interviews Contrasting staff & service user views Implications for practice Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Methods overview Three local authorities Semi-structured interviews with staff and service users Consent In person or via telephone Lasting between 30 and 90 minutes Audio-recorded and transcribed Analysis Thematic analysis Facilitated by qualitative data management software Quality assessed at all stages Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Staff interviews Objectives To understand staff members perceptions and experience of Risks and opportunities of PBs & DPs Links between safeguarding & support planning Participants Senior manager/s of adult social care Elected representative Front-line managers & practitioners – assessment and/or safeguarding of adults Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Service user interviews Objectives To understand budget-holders experiences of Personal budgets Risk assessment Safeguarding processes Participants 10 budget-holders & 7 proxy budget-holders Final inclusion criteria Over 18 years of age AVA referral case (not just AVA alert) Receives a PB and/or a DP Safeguarding process commenced & resolved in the last year Capacity to give consent and take part in an interview Not currently in 'crisis‘ Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Participants Staff: n=16 6 social workers 5 team managers 3 senior managers 2 elected members Service users: n= 12 DP/PB holders (40%) 6 people with learning difficulties 5 people who were physically disabled 1 person with mental health and physical problems Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Staff interview findings (1) Contexts Financial constraint – higher eligibility criteria, greater unmet need, service quality Personalisation adoption Poverty – driver of abuse (PAs and family) Practitioners understanding of risks of PB/DPs Increased risk of financial abuse – inc. from proxy BHs Affects level of monitoring Risks associated with employing PAs Reduce risks – choice, control No change in level of risk – circumstance not PB/DP Minimising risks Varying control over DPs as a response to risky situations Monitoring and review – financial monitoring Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Staff interview findings (2) Balancing choice and control Autonomy versus duty of care Balancing positive and negative risks Safeguarding and personalisation practice Timeliness of information – post incidents Recommendations about pre-employment checks Role of support planning – generic risks Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Service user findings (1) Awareness Support funding Safeguarding issue - recognition & reporting Safeguarding process Information Poor information before agreeing to DP/PB – risks, employer role Lack of information when changes implemented Safeguarding issues and processes Different types of abuse described Multiple abuses – overtime and concurrently Support staff/personal assistants - often quality related Processes unclear, especially for people with PAs. Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Service user findings (2) Outcomes of safeguarding investigation Change of support worker/agency Advice from advocacy organisations on future safeguarding 3 -month probationary period for PAs Revised employment processes Choice, control and independence Around choice of funding Around decisions about support Around risk management Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Overlaps & contrasts Information giving Funding arrangements Choice of care provider/agency Being an employer Safeguarding processes Continued review and support Choice and control Assumption of choice for service users Feeling of little choice by service users Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Implications for practice What are the implications of these findings for practice? What are the implications for service users? Are any changes needed to practice? What changes might be needed? How would these benefit staff and service users? Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Research Team Martin Stevens: martin. stevens@kcl. ac. uk Fiona Aspinal: fiona. aspinal@york. ac. uk Shereen Hussein: shereen. hussein@kcl. ac. uk Mohamed Ismail: mohamed@analyticalresearch. co. uk Jill Manthorpe: jill. manthorpe@kcl. ac. uk Kritika Samsi: kritika. 1. samsi@kcl. ac. uk John Woolham: aa 7970@coventry. ac. uk Kate Baxter: kate. baxter@york. ac. uk Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog

Risk, Safeguarding and Personal Budgets: Do personal budgets increase the risk of abuse? Staff and service user experiences Martin Stevens, Jill Manthorpe and Kritika Samsi Shereen Hussein: King’s College London Mohamed Ismail: Analytical Research Ltd John Woolham: Coventry University Fiona Aspinal, Kate Baxter: University of York Twitter: SPRUYork Email alerts: bit. ly/email. Spru Blog: bit. ly/Sprublog