Has self-neglect made safeguarding murky?

I suspect most practitioners were surprised to see The Care Act was very thin when it came to safeguarding. It wasn’t until the Statutory Guidance draft in June did we see the familiar list come to being again – with the added abuse ‘exploitation’. Of course, this was rather pointless as exploitation is involved in all abuse – there is always an exchange of power.
Then the final Care and Support Statutory Guidance in October makes further changes. Some of which are rather good – It removes exploitation sensibly.   Adding Domestic Violence was welcome – although I think it should read Domestic Abuse. The change to Organisational from Institutional – some have noted is also an improvement, as this is more likely to include a wider scope of provision and not just residential care. I for one, would have preferred it to read Organisation/Institutional as now the Community Care Act 1990 is no longer law – I am rather concerned that the Care Act is not specifically endorsing the right for people to be supported in ordinary not institutional environs. I guess, the older persons sector has always ignored that ideology with care homes of over 100 beds. Nothing ordinary about that.
The adage of Modern Slavery is vital – and reminds us all of the increasing and shocking examples of mainly migrants fleeing poverty to come to the UK to find a life, only to be forced into labour and sex work, having their passports removed and any means of escape barred. I imagine most of us are both pleased that it has come into safeguarding, as well as rather saddened by the need for it.
It’s the final list entry – self-neglect – that seems to be the most controversial. At the same time as the Local Authority loses its powers to intervene with the repeal of The National Assistance Act, there is now a duty to treat self neglect as an abuse. For so many reasons I find it preposterous to have this as an abuse. In the first instance, the definition of abuse the guidance chooses to define abuse as involving a perpetrator and a victim. Where is the perpetrator in self-neglect, if the person has capacity?   Surely, where a person does not have capacity then it is neglect and not self neglect that applies. I would also stress that it is almost impossible for practitioners to agree on what constitutes self neglect. Who decides? Against what standards? I smoke and to many non smokers, this may be seen as self neglect and arguably it is. Frankly, this adage makes a mockery of the rather wonderful 6 key principles of safeguarding:

These words were well considered and appear in a very precise order. I am rather enjoying this when training safeguarding. The idea that we start with the empowerment and rights and choice – supporting the person to retain or regain capacity is a vital place to start in safeguarding. Everything we do in care provision is safeguarding and prevention – from health and safety standards to supervision and training. And supporting the person to prevent abuse is key to empowerment. Proportionality is placed here and this makes sense of the whole list – If we are going to intervene, then we must understand and apply the Mental Capacity Act and ensure that we use the least restrictive approach when acting – making sure our actions are proportionate to not only the outcomes, but also the person’s right to be in control of their own decision making. Protection is necessary when a person does not have capacity and may be more interventionist, expecting partnership working where those involved are sure of their responsibility and held accountable. I adore this list. It helps all practitioners truly understand the ideology of safeguarding. Where exactly does ‘self-neglect’ fit in here? If the person has capacity, then empowerment and prevention is the proportionate response. If the person does not have capacity then we need to protect and not doing so would constitute neglect.
I am at odds as to how to justify self-neglect as an abuse at all. I have the right to choose my lifestyle which, if you looked in my dusty corners, some may say is self-neglect.
The change from investigation to enquiry – don’t get me started! – that will have to wait for another rant.
Blog by Trish O’Hara – Dec 2014

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