Welcome to this short podcast on behalf of the West Sussex Safeguarding Adults Board, which will give you information about the outcome of the self-neglect audit we carried out in 2022. This audit looked at the records of ten people where self-neglect had been identified and aimed to: evaluate and reflect on practice, learn from experience, inform multi-agency practice development, and strengthen multi-agency working.
So, firstly, I would like to give you the criteria for this audit.
We looked at the records of five Adults supported via the safeguarding pathway, and five Adults supported via a multi-agency care management pathway, such as the self-neglect procedures. For the Adults supported via safeguarding, they must have been involved in a safeguarding enquiry in the twelve months preceding the audit and, there must have been multi-agency involvement with the Adult. Further details about the Adults such as their ages, ethnicities, gender, and support needs, can be found in the learning briefing which accompanies this podcast.
So, now I want to share with you the five key themes identified from the audit where improvement is needed.
The first was, self-neglect being identified and recorded. The audit found that there was a lack of identifying self-neglect, accurate record-keeping of work undertaken, and sharing of information with others. This is important to meet legal requirements and professional duties as well as ensuring accountability and evidence of your interventions. It is, therefore, now important to explain some of the signs you need to look out for to identify and accurately record self-neglect.
Signs of self-neglect may be seen in the environment such as homes being excessively unclean or cluttered, signs of vermin or hoarding. There could also be signs in relation to self-care such as having an unkempt personal appearance, appearing malnourished or dehydrated or declining essential health or social care support. If self-neglect is identified, it is key to understand processes to support the Adult. Safeguarding processes may be required if there are significant risks, for example, the Adult is living in squalid or unsanitary conditions that mean life is in danger or lack of self-care which could lead to a significant impact on health and wellbeing.
Lower levels of risk will not require safeguarding and could be managed by using the multi-agency self-neglect procedures, carrying out a Care Act assessment, or signposting to or arranging physical or mental health support.
The second area of improvement was identifying a lead agency to coordinate support. So, who would lead?
If there is a Safeguarding Enquiry, it is likely that the lead will be the Local Authority. However, they will not always be the best placed agency. This could be because there is another agency who is already involved and has a duty of care, holds significant information about the Adult, or the Adult has shown a likelihood to engage with them. It could also be that the Adults needs best relate to the service provided by that agency. In the multi-agency self-neglect procedures there detailed information about the process that you should follow.
The third area for improvement was Mental Capacity.
The audit found that Mental Capacity Assessments weren’t routinely considered and recorded. These assessments are crucial to determine whether a best interest process is required and will evidence how capacity may be different for different decisions, and how capacity may change over time.
Whilst an Adult should be presumed to have capacity to make decision, if in doubt, an assessment must be carried out. This must be time and decision specific and be accurately recorded. Consider if the Adult can understand, weigh, retain and tell you, what the risks are, if they know their behaviour places them at risk and the consequences of taking these risks.
Some adults may have fluctuating capacity. This fluctuation can take place over hours, days, or weeks. If possible, carry out the assessment when the adult is at their highest level of functioning. If a person has fluctuating capacity and an action is immediately required a best interest process should be considered. If a person has capacity and chooses to make an unwise decision, this doesn’t mean no action is required; other actions may include comprehensive risk assessment.
The Self-Neglect Procedures contain more detailed guidance and further information including, Decisional and Executive capacity, Inherent Jurisdiction, Best Interest Decisions, and the Court of Protection.
The fourth area is making safeguarding personal, also known as MSP.
MSP is a personalised approach that ensures safeguarding processes are carried out with, and not to, the Adult. When raising self-neglect concerns it is vital that all interventions fully include and involve the Adult.
Professional curiosity is also key to keep adults safe from harm. It is important in helping to identify self-neglect and can ensure that the right information is gathered to assess needs and risks.
The fifth and final key theme is multi-agency meetings.
Given the complex nature of self-neglect, multi-agency meetings are often the best way to ensure effective information-sharing, communication and, a shared responsibility for assessing risks and agreeing an action plan. The lead agency will be responsible for convening this meeting, but any involved professional can request one. At the meeting, a decision will be made about how to best involve the adult as early in the process as possible.
In the Multi-Agency Self-Neglect Procedures there is further details on multi-agency meetings including; the purpose and reasons, timescales, outcomes, minuting of meetings, and seeking legal advice.
Where an individual is putting themselves or others at significant risk by refusing services and all options have been explored and the level of risk is still high, a referral to the Multi-Agency Risk Management Subgroup also known as MARM should be considered.
So, what can you do to improve your knowledge and practice on the themes raised from this audit?
Well, we have several resources that can be accessed to support improving your practice in relation to the five key areas identified by the audit. Links to these are included in the learning briefing accompanying this podcast. We would also recommend that you discuss the learning from this audit and any good practice initiatives you have with your supervisor and team to reflect on how practice can be improved.
Thank you very much for your time to listen to this podcast, and we appreciate your support to make a real difference to Adults experiencing self-neglect in West Sussex.