ADULTS SERVICES SCIE REPORT 45. The governance of adult safeguarding: findings from research into Safeguarding Adults Boards

Transcription

1 ADULTS SERVICES SCIE REPORT 45 The governance of adult safeguarding: findings from research into Safeguarding Adults Boards PUBLISHED SEPTEMBER 2011

2 ADULTs SERVICES ADULTs SCIE REPORT SERVICES 45 The governance of adult safeguarding: findings from research into Safeguarding Adults Boards Suzy Braye, University of Sussex David Orr, University of Sussex Michael Preston-Shoot, University of Bedfordshire Final Report to the Department of Health i

3 First published in Great Britain in September 2011 by the Social Care Institute for Excellence SCIE 2011 All rights reserved Written by Suzy Braye, David Orr and Michael Preston-Shoot This report is available online Social Care Institute for Excellence Fifth Floor, 2 4 Cockspur Street, London SW1Y 5BH tel fax Front cover photograph supplied by Photofusionpictures.org ii The governance of adult safeguarding

4 ADULTs Contents SERVICES Contents Executive summary vi Key findings summarised from the main report 1 Methodology 1 Findings 2 Strategic goals and purpose 2 Structures 3 Board membership and network patterns 7 Board functions 11 What accountabilities are engaged by the work of the Boards and 14 how are these expressed? Concluding observations on governance 15 Part I: Introduction and methodology 20 1 Background 20 A note on terminology 22 2 Methodology Overall aims of the research Overview of data sources Systematic literature review Workshops Board documentation Key informant interviews Regional and national work programmes Ethical approval 26 Part II: Research findings 27 1 Introduction 27 2 What are the strategic goals and purpose of Safeguarding Adults Boards? Definitions and scope Definitions and scope in Board documentation, workshops and key informant discussions Definitions and scope in the literature Summarising definitions and scope Strategy versus operations 46 3 How are Boards structured? The relationship between form and function Sub-groups Horizontal differentiation Vertical differentiation Coordination 60 iii

5 3.3 Structural links beyond the Board Links with other partnerships Links beyond the Boards own localities 66 4 What are the patterns of Board and network membership? Interagency working: themes from the literature Findings on Board membership Agencies participating in membership Who the members should be Duties of membership The safeguarding manager s relationship with the Board Chairing the Board Appointment of independent chairs Role specification Regional pictures Additional rules of engagement Frequency of meetings Quoracy Meeting protocols Budgets and financial regulation Participation on the Board by people who use services and carers The literature Board documentation Workshop discussions What do Boards do? How do they pursue their functions? Overview Strategic planning Setting standards and guidance Quality assurance General approaches to quality assurance Serious case reviews Promoting participation Awareness raising and publicity Capacity building and training Relationship management Monitoring the Board s own performance in pursuing its functions What accountabilities are engaged by the work of Boards and how are these 161 expressed? 6.1 Accountability Mechanisms for giving account: the annual report Board authority Concluding observations on governance Generic governance considerations Comparison across sectors Ways forward for adult safeguarding 184 iv The governance of adult safeguarding

6 ADULTs SERVICES References 189 Appendix 1: Overview of the literature review 195 Approach taken 195 Searching 195 Screening 196 Screening strategy 196 Screening results 197 Keywording 197 Synthesis 198 Categorisation of the literature reviewed 198 Limitations 199 Appendix 2: Search terms and databases 201 Appendix 3: Search results flow chart of process 205 Search results by database 205 Appendix 4: Keywording strategy 206 Appendix 5: Review of Board documentation 212 Construction of the sample 212 Documentation reviewed 212 v

7 Executive summary The research for this report explored the governance arrangements for safeguarding adults. Drawing on a systematic review of the literature, workshops attended by safeguarding specialists, a survey of Safeguarding Adults Boards documentation, key informant interviews and data from regional and national safeguarding work programmes, the findings focus on five key features of Safeguarding Adults Boards. Strategic goals and purpose Boards engage in activities that are far wider than those implied by the current definitions in No secrets (DH, 2000); from a core focus on protecting vulnerable adults from abuse, their work extends to community prevention and awareness raising. The scope is potentially limitless, but some areas of risk are not routinely encompassed notably suicide and self-neglect. There was consensus that, in the context of personalisation, the language of safeguarding should move away from an emphasis on vulnerability to a perspective that recognises the strengths and capabilities of an individual, and empowers their own decision making and self-protection. Boards commonly set out principles that underpin their work, emphasising respect for human rights, autonomy and empowerment, equality, proportionality, confidentiality and participation. Capacity is recognised as a key factor in determining respect for autonomy of decision making. Structures Board structures must balance the need for a tightly defined core group of senior officers to provide strategic leadership, with the wish to be inclusive of a wide range of stakeholders. Layered structures are common, with differentiation between strategic and operational responsibilities, and sub-groups taking responsibility for distinct functions such as training and quality assurance (QA). Coordinating mechanisms vertical channels of communication between layers in the hierarchy, and horizontal communication channels between sub-groups are vital in maintaining a coherent and coordinated overall structure. Strategic links with other partnerships in a locality are an essential element of a Board s location within broader locality structures, although it is sometimes difficult to ensure safeguarding is on the broader agenda. Some Boards also create strong links outside their own area. Independent chairs network informally with each other, and regional Joint Improvement Partnerships (JIPs) work on safeguarding is experienced as helpful in sharing good practice. Board membership and network patterns Good interagency working at Board level is promoted by a history of joint working, information sharing protocols, goodwill/positive relationships between individuals and mutual understanding/shared acknowledgement of the importance of adult protection. It is hindered by poor information sharing, vi The governance of adult safeguarding

8 ADULTs SERVICES limited understanding of roles, non-attendance or involvement of key agencies at meetings and conflicting organisational priority given to safeguarding. There is no common pattern of membership, and this flexibility allows for adjustments to local requirements. Statutory partners (adult social care, health and police) form the core, with a wider range of members (independent sector providers, other statutory networks and partnerships, and advisory/consultative networks) participating to variable degrees, and with less clearly defined roles and expectations. Open public consultation meetings and events may fill membership gaps by allowing for an even wider range of perspectives to be heard. There is a strong push for seniority of membership in the Board, so that members can make strategic decisions and commit resources on behalf of member organisations, act in a leadership role as safeguarding champion within their own organisation, and have the authority to hold their own agency to account for its safeguarding performance. Independent chairing is much debated, and the number of independent chairs is growing. Independent chairing brings perceived advantages transparency, objectivity, mediation, challenge and scrutiny. Perceived disadvantages include distancing of the local authority from its lead role, costs, lack of authority and lack of insider knowledge. The role of the chair is rarely specified, although independent chairs are more likely to have a job description. Accountability of the independent chair is seldom made explicit, and reporting mechanisms are diverse. Boards have detailed rules of engagement that govern the conduct of their business. Funding, however, is often problematic and securing resources for the work of the Board is a challenge. Boards increasingly use business planning models to make the case for robust support. Membership of Boards by people who use services and carers is not routinely established, although proactive work is done to build capacity for participation, and to secure advocacy to support involvement. Board functions The activities undertaken most commonly by Boards can be grouped into seven broad areas of key strategic importance: strategic planning; producing policies, procedures, protocols and guidance; QA (including serious case review); promoting participation by people who use services and carers (both in their own safeguarding and in the work of the Board); awareness raising and publicity; training and workforce development; and relationship management. What accountabilities are engaged by the work of the Boards and how are these expressed? There are two main routes through which Boards account for their work, to the Council and to the Local Strategic Partnership (LSP). However, there is no consistency; some Boards report to both, some to one, and some to neither. Other reporting routes are diverse and the diversity masks a lack of clarity about the accountability functions being fulfilled. In a world of partnerships and strategic alliances, formal hierarchical lines of accountability are difficult to discern and the notion of an accountability matrix is more helpful than any hierarchical model; some forms of accountability serve the function of scrutiny, while others develop vii

9 the Board s activities in line with stakeholder needs and priorities. In relation to the accountability owed by members to the Board, it is sometimes unclear what authority a Board holds in relation to its members; member agencies commonly retain the right to determine their adherence to the Board s decisions. The Board s authority is a consensual authority, exercised over its members through their agreement. Memoranda of Understanding created between Board members thus have an important function in codifying the permissions that member agencies accord to each other. Concluding observations on governance Robust governance arrangements will be assured by the following Board features: strong statements of strategic purpose and scope, with explicit multiagency commitment clear structures with explicit divisions of responsibility and robust coordinating mechanisms explicit commitments on membership, in roles that are understood and agreed, including clarity on the authority of the Board in relation to member agencies broad stakeholder involvement clarity on the role and status of the chair, and Board rules of engagement, including resources strategic leadership on a range of functions, including strategic planning, policy and procedural guidance for member agencies, performance monitoring and quality improvement explicit involvement of people who use services and carers in the work of the Board, and standards for their empowerment in all safeguarding activity clear internal standards for Board performance, and clear external accountability routes. Specific legislation that sets out for Safeguarding Adults Boards roles and functions, membership and accountabilities, would help to standardise policy and procedures, to hold agencies more easily accountable, to clarify responsibilities and to ensure participation, in ways that guidance, differentially binding on the partners, has not so far been able to do. viii The governance of adult safeguarding

10 ADULTs SERVICES Key findings summarised from the main report This section provides an easy reference overview of the main findings. Introduction The Department of Health (DH) commissioned the research reported here. It took place between December 2009 and May 2010 and, drawing on evidence both from the literature and from the practice of Safeguarding Adults Boards, explored the governance arrangements for safeguarding adults in England. Safeguarding adults is a multiagency responsibility, guidance on which (No secrets, DH, 2000) has been subject to public and political scrutiny. Under the guidance, local authorities were encouraged to consider structures for interagency collaboration and it is these that have become known as Safeguarding Adults Boards. Membership includes statutory and independent agencies engaged in adult social care, community organisations and groups, including people who use services and carers. Directors of adult social services carry specified lead responsibility and authority in this context. Methodology The specific questions addressed in the research were: What are Safeguarding Adults Boards for? What are their strategic goals, vision and purpose? How are Boards structured? What patterns of membership do Boards show? What do Boards do? How do they pursue their functions? What accountabilities are engaged in the work of Boards and how are these expressed? The data sources used were: a systematic review of the literature workshops attended by Board chairs, directors of adult services, safeguarding leads and others with specialist safeguarding roles, including participants from the NHS and the police survey of documentation from a sample of individual Boards key information interviews data from regional and national safeguarding work programmes. Ethical approval was granted by the Social Care Research Ethics Committee (REC reference number 09/IEC08/19). 1

11 Findings The research findings relate to five key aspects of governance as expressed through Safeguarding Adults Boards: strategic goals and purpose, structures, membership and network patterns, functions and accountabilities. Strategic goals and purpose While much Board activity is directed to setting strategic frameworks for safeguarding individuals, Boards also engage in activities that are far wider than those implied by the current definitions in No secrets (DH, 2000), which focus primarily on responses to individual situations of abuse. In practice their remit goes far beyond populations in need of community care services, and encompasses work with wider communities and groups. This wider work tends not to be proceduralised but is often conducted through awareness raising with other bodies and partnerships, and/ or directly with communities, that is, across the whole range of a local population. Where this work is preventive in nature, its scope is potentially limitless. There are, however, some areas of risk that are not routinely encompassed within the scope of safeguarding notably suicide and self-neglect although safeguarding work in practice does take place with people risks to themselves, and a number of serious case reviews explore how interagency networks have responded in cases of self-neglect. A broader focus in strategic goals and purpose was seen as appropriate in the context of personalisation, where goals shift from protective interventions determined by professionals to supporting people to engage in self-protection in the context of autonomous decisions. Boards are working to embrace personalisation and to promote more empowering ways of working with individuals and communities, while also recognising that self-directed support might open up new risks, and requires new ways of working to ensure that people have access to safeguarding when they need it. There was consensus that, in the context of personalisation, the language of safeguarding should move away from an emphasis on vulnerability to a perspective that recognises the strengths and capabilities of an individual, and empowers their own decision making, supporting the ability to protect oneself from risk. The scope of adult safeguarding may be represented in the diagram opposite. 2 The governance of adult safeguarding

12 ADULTs SERVICES Community engagement Preventative functions 1. Community awareness raising 2. Specific initiatives to address identified harm to groups Reactive functions 3. Education/risk management initiatives 4. Investigation and protection planning Individual engagement Boards set out a range of key principles that underpin their work, emphasising recognition of and respect for human rights, autonomy and empowerment, equality, proportionality, confidentiality and participation. Capacity is recognised as a key factor in determining respect for autonomy of decision making, but it is recognised that a duty of care in the context of risks to others may require intervention to be pursued. The notion of dignity is sometimes used as a balancing factor, driving work that seeks to empower people to envisage the possibility of choosing abusefree options for themselves. The rights of carers, care providers and staff are also recognised, along with a duty of care to people who present risk of harm to others where they themselves have needs. Boards are also moving to a more strategic focus in relation to the scope of their activity. There is a strong push for strategic leadership by Boards leadership in respect of interagency collaboration and coordination, as well as change agency in relation to safeguarding scope and approach and a separation from operational matters. This has implications both for structure and function (covered in later sections of this summary). Structures There is a tension between the need to create a tightly defined strategic group of senior officers who can commit their agency to decisions, and the wish to include a wide range of stakeholders in the Board. This results in a wide diversity in the number of Board members, with anything between 10 and 47. The broadening of scope of safeguarding has brought some increase in membership, as Boards seek to engage with community groups, and with other partnerships in a locality, and with the diversification of structures within statutory partners such as the NHS. 3

13 In response to the perceived need to create efficient bodies, and also to the push for strategic roles to be strengthened, Boards are creating layered structures where each tier holds a different level of responsibility, from strategic to operational. In some cases the Board restricts its membership but creates an operational board or group with responsibility for implementing Board strategy. In other cases the Board remains wide and inclusive but an executive group, with responsibility for leadership and strategic decision making, sits above it. There is therfore a degree of horizontal differentiation. Whether the Board operates as a full board or a smaller executive, it is common for sub-groups to then take responsibility for coordinating different strands of activities, thus creating vertical differentiation between areas of responsibility and functions. Each Board clusters its functions into sub-groups in slightly different ways, but will typically run three, four or five groups covering these elements between them. All groups are commonly constituted with a degree of formality, with Terms of Reference and membership requirements, formal authority and accountabilities. 4 The governance of adult safeguarding

14 ADULTs SERVICES Training and workforce development Policy, procedures and practice development Quality assurance Communications and publicity Serious case reviews Short life task and finish groups Locality based groups Groups to promote participation by people who use services and carers Groups to promote practitioner liaison Groups to bring other stakeholders together Specialist interest groups 5

15 Safeguarding Adult Boards Safeguarding Adults Operational Group Sub-Group 1 Sub-Group 2 Sub-Group 3 Sub-Group 4 The more differentiated the structure, the more important become the coordinating mechanisms vertical channels of communication between layers in the hierarchy, and horizontal communication channels between sub-groups that are performing differentiated functions in order to maintain a coherent and coordinated overall structure. Strategic links with other partnerships in a locality are an essential element of a Board s location within broader locality structures. These take a number of different forms, as they perform different functions in relation to the Board s strategic alignment and accountabilities. Despite the importance of strong links with local partnerships, it is sometimes difficult to get safeguarding on their agenda. Some Boards also create strong links outside their own area to discuss joint approaches, to agree cross-boundary protocols, to adopt joint procedures and approaches to practice, to run shared sub-groups and shared training. Accountability links Links with other Safeguarding Adults Boards SAB Links with other coordinating partnerships Links with those who need to know Independent chairs also have links with each other, which are experienced as helpful in supporting their role. Regional JIP work programmes on safeguarding are experienced as helpful and supportive in developing and sharing practice. 6 The governance of adult safeguarding

16 ADULTs SERVICES Board membership and network patterns The core goal of interagency collaboration that is central to Boards strategic purpose is reflected in their membership. Good interagency working at Board level is promoted by: a history of joint working information-sharing protocols goodwill and positive relationships between individuals mutual understanding and shared acknowledgement of the importance of adult protection. Good interagency working at Board level is hindered by: poor information sharing limited understanding of respective roles non-attendance or involvement of key agencies at meetings conflicting organisational priority given to safeguarding. There is no common list of members to which all Boards work, and this flexibility allows for adjustments to local requirements. There are, however, some patterns, and membership commonly falls into different categories, with statutory partners (adult social care, health and police) forming a core, and a wider range of members participating to a lesser or greater degree, and with less clearly defined roles and expectations. Advisory and consultative networks Independent sector: providers of care and support services Network of other statutory agencies and partnerships Statutory core: adult social care, health, police Membership may be expressed through participation in sub-groups or forums rather than in the Board itself. Some members may participate in an advisory role for example, legal advisers, Crown Prosecution Service (CPS), Care Quality Commission (CQC). Lack of coterminosity can present challenges to consistency a single 7

17 organisation may be required to work in very different ways by several different Boards. There are challenges too in securing participants who might represent their sector this was particularly the case in relation to independent sector providers. Gaps are filled sometimes through open public consultation meetings and events that engage people in the work of the Board, even if they do not have membership. There is a strong push for seniority of membership in the Board. Important attributes are ability to: make strategic decisions and commit resources on behalf of member organisations act in a leadership role as a safeguarding champion within their own organisation have the authority to hold their own agency to account for its safeguarding performance understand safeguarding issues or act on specialist advice on safeguarding. Membership of Boards is seen as creating a number of obligations on those who take it up, at both agency and individual level. These are commonly set out in detail in Board documentation, and with some formality, requiring members, for example, explicitly to sign their acceptance of the terms and conditions. For the agencies involved, membership requires them to act to: ensure the agency has rigorous procedures for recruitment and selection of staff provide staff with clear operational guidance and appropriate training in areas of potential safeguarding risk ensure risk assessment procedures are in place, along with mechanisms for embedding safeguarding in care plans ensure robust procedures for recording, reporting and reviewing incidents of harm ensure robust procedures for responding to allegations against members of staff publish a whistleblowing policy ensure implementation of No secrets and the multiagency procedures monitor the quantity and quality of safeguarding work within their agency and provide monitoring information to the safeguarding coordinator provide an annual report on work undertaken that is linked to strategic objectives and key tasks, for inclusion in the annual report designate a lead officer contribute to the strategic direction of the Board. Individual members must make commitments also: acting as a communication link between the Board and their agency in terms of disseminating strategy and operational priorities and ensuring that these are met securing resources to support the work of the Board (either financial contribution or through staff time and expertise) 8 The governance of adult safeguarding

18 ADULTs SERVICES alerting the Board to any issues of safeguarding strategy or operations that arise in their agency ensuring staff participation in relevant training and development work monitoring their agency s compliance with procedures complying with QA initiatives such as audit and case review ensuring their agency engages in information sharing with other agencies in order to pursue safeguarding goals ensuring their agency participates as appropriate in management reviews as part of serious case review processes providing regular feedback to the Board, and an annual written report, on their agency s safeguarding work ensuring that their agency contributes actively to the work of sub-groups and task groups, possibly including a chairing role acting as a safeguarding voice in all their other work (for example with other committees). Nolan principles ( The seven principles of public life set out in the First Report of Lord Nolan s Committee on Standards in Public Life) are sometimes used as benchmarks for the conduct of Board members. The safeguarding manager or operational manager with lead responsibility for safeguarding in the local authority often has a key role in relation to the Board. This may be an advisory, coordination and operational role; in some cases the safeguarding manager is accountable to the Board. In relation to chairing the Board, the question of independent chairing was a much debated topic, and the number of independent chairs is growing; many Boards still chaired from within the agency membership (usually by the director of adult social services or other senior officer) were exploring the appointment of an independent chair, and the experiences of those with independent chairs were largely very positive. Three regions have undertaken work on independent chairing, a measure of the level of interest in what it has to offer Boards. Independent chairing of the Board brings a range of perceived advantages, notably transparency, challenge and scrutiny: capacity for greater degree of challenge to the collective safeguarding system ability to identify and allocate responsibilities without agency self-interest fairness in holding agencies to account a mediator for interagency power relations external credibility in the public perception. There were also some perceived disadvantages: potential distancing of the local authority from its lead role potential reduction of involvement from senior local authority personnel lack of authority to resolve difficult interagency political issues potential for abdication of responsibility by key statutory agencies 9

19 lack of insider knowledge, making it difficult to intervene in local politics and agendas costs. If these disadvantages did occur in practice, there was little evidence that they were irresolvable or had adverse effect on the Board s functioning. The exception to this was the undoubted financial cost of payments made to those in independent chair positions, although it was also clear that by no means all independent chairs were paid. The role of the chair was rarely specified, although Boards that had recently appointed or were considering the appointment of independent chairs had, as part of an open recruitment policy, developed their thinking on expectations and attributes and produced person specifications. Accountability of the independent chair is seldom made explicit, and is complex. In reporting terms, it may be to the: director of adult social services chief executive of the council executive board of the safeguarding partnership. Each of these lines of accountability has pros and cons, and may compromise independence, or perceived independence. Boards have detailed rules of engagement designed to ensure that their business is conducted in a robustly regulated manner. These include specification of: frequency of meetings quoracy meeting protocols budgets and financial regulation. The question of funding for Boards has in many areas been problematic, and securing resources for the work of the Board is a key challenge. The position of Safeguarding Adults Boards compares unfavourably with Safeguarding Children Boards where resource commitments are much clearer. Adults Boards rarely have their own dedicated budgets. Where they do, costs are often shared between the lead statutory partners social care, health and police. The default position, in the absence of cost sharing, was that the local authority funded the work of the Board; partner agencies were sometimes reluctant to commit financial resources, but contributions to costs were frequently made in kind. The lack of a national performance indicator on adult safeguarding was identified as a barrier to securing resources through the LSP framework, but Boards are increasingly using business planning models to make the case for robust support for their work. Membership of Boards by people who use services and carers is not routinely established, and is the subject of some debate. Those in favour advocate very strongly from a position of principle that participation in Boards is the right way forward. Some very proactive work is being done to build capacity for participation in Boards, and to secure advocacy and support for people who use services in this context. 10 The governance of adult safeguarding

20 ADULTs SERVICES Other participants questioned the purpose of participation in Board discussion, and considered that more effective engagement with the perspectives of people who use services could be achieved through other mechanisms for participation (which are covered in a later section of this summary). Participation in Board activity is more established at sub-group level, with a number of examples found of groups and forums designed to be inclusive of people who use services in relation to the Board s business. The research found no examples of specific protocols for participation, and where membership was offered it was not always clear how representation was determined, and whether places were taken by people who use services and carers themselves or by the staff of organisations working on their behalf. Board functions The activities undertaken most commonly by Boards can be grouped within seven broad areas that have key strategic importance. Relationship management Capacity building and training Strategic Stategic planning BOARD FUNCTIONS Setting standards and guidance Quality assurance Awareness raising and publicity Promoting participation Strategic planning derives directly from Boards core engagement with strategic leadership for adult safeguarding; some adopt a clear planning model in which strategic goals give rise to operationalised priorities, and clear action steps for which responsibility is allocated. Producing policies, procedures, protocols and guidance is one of the key ways in which Boards attempt to secure adherence to standards of practice in the many agencies whose work contributes to safeguarding. Standards and guidance commonly cover the following aspects of safeguarding: > > how multiagency cooperation is operationalised > > how values underpin safeguarding practice > > what procedures are to be followed in safeguarding investigations 11

21 > > how aspects of practice at which agencies interact are to be managed information sharing, data protection, confidentiality > > preventive strategies through good practice in care > > legal frameworks > > challenging aspects of decision making, such as capacity and consent > > the interface between safeguarding and risk areas such as honour violence, hoarding, domestic abuse, forced marriage > > interagency conflict resolution > > cross-border protocols > > case review > > training and workforce development > > complaints procedures > > whistleblowing policies > > protocols relating to liaison with specific sectors such as financial institutions. Mechanisms for QA include: > > audit and inspection of agencies providing care, to ascertain compliance with safeguarding requirements > > improvement action plans > > commissioning and contracting practice > > monitoring of statistics on safeguarding activity > > case file audit > > audit of compliance with procedures > > self-evaluation by case holders > > serious case review action plans, and learning explicitly fed back into practice > > long-term quality improvement work streams built into business planning > > regular reports from member agencies on performance in their safeguarding role > > external peer review > > evaluation of training. Serious case reviews, although not mandated by statutory regulation, are increasingly used as a means of reviewing interagency safeguarding practice, and are a key quality improvement tool when the findings are disseminated and lead to target action for improvements to interagency practice. The Association of Directors of Adult Social Services (ADASS) protocol on serious case reviews (ADSS, 2005a) is widely adopted; Boards commonly issue detailed and extensive guidance on the conduct of reviews. Their effectiveness, however, may be compromised by lack of interagency engagement in the review process in the absence of a duty to cooperate. Management reviews within agencies were also thought to require strengthening. The findings of serious case reviews are not collated at national level, and thus broader impact may be limited. Participation by people who use services and carers in their own safeguarding is seen by Boards as a key area for development. There are some proactive and well-established practices, but these are by no means consistent. Developments include: > > procedures that emphasise the importance of ensuring participation during individual safeguarding investigations > > audit of compliance with procedures 12 The governance of adult safeguarding

22 ADULTs SERVICES > > advocacy services and other forms of support explicitly provided to promote participation > > debriefing and review services to ascertain satisfaction > > research into the experiences of people who have been through safeguarding processes > > post hoc surveys of the experiences of people who use services. One example was found of very proactive engagement through a forum for people who use services that meets twice a year. It has undertaken major projects to empower people who use services through: > > developing user-defined standards and outcomes for adult safeguarding > > devising a charter for people who use services involved in safeguarding > > devising an audit tool for use by the Board and by partner agencies to benchmark their practice against standards for people who use services > > delivering a series of workshops to develop and test out ways of staying safe > > training people who use services to deliver staying safe training to others > > participation in the Board by two representatives of the forum > > development of a contract to express how the Board will account to the forum for its work. Facilitators of empowering levels of participation appear to be: The vision and will to make it happen Support and leadership from senior staff Support and leadership from forum participants Openess and honesty of communication Commitment to a rights-based approach Commitment from the multiagency board Creativity and imagination in ways of communicating Resources mainly time and energy rather than money Awareness raising and publicity has two main targets: > > education of the general public about safeguarding 13

23 > > education of groups thought to be particularly at risk, in order to enhance self-protective capacity. Engagement with training and workforce development is widespread, and is one of the most longstanding functions of Boards. There has been little attention, however, to the outcomes of training provided, thus making it difficult to assess the effectiveness in terms of practice and impact for people who use services. Relationship management: Boards have a clear change management role in terms of creating the necessary interagency relationship infrastructure in which safeguarding practice can thrive. Boards recognise the need to monitor their own performance, and are doing so through the use of a range of mechanisms. ADASS standards (ADSS, 2005b) have been clearly influential in setting out expectations, and other more recent work to support peer review of Boards provides a framework for benchmarking the strength of the Board s own working together practices, essentially focusing on leadership, QA, strategic alliances, participation and accountabilities. What accountabilities are engaged by the work of the Boards and how are these expressed? Two dimensions of accountability that have emerged in this research. First is the accountability of the Board to external bodies to which it owes an account of its work. There are two main directions discernible here: accountability to the Council, expressed through the Overview and Scrutiny Committee, or to the Cabinet accountability to the LSP, expressed through its Health and Wellbeing Partnership, or the Crime and Disorder Reduction Partnership (CDRP). Some Boards report to both, some to one, and some to neither of these; other reporting routes include to the council executive through the director of adult social services, to people who use services and carers, to partnerships such as the multiagency risk assessment conference (MARAC) and multi-agency public protection arrangements (MAPPAs), to the mayor, to the NHS primary care trust (PCT) board, to NHS trust boards and to the managing boards/trustees of partner agencies. The annual report is often a means of giving an account of the Board s work and thus serving some of the functions of accountability arrangements. This diversity of reporting routes masks a core lack of clarity about different accountability functions that are being met by reporting through the various channels. Accountability liability to give an account to others for one s actions and decisions is core to governance. But in a world of partnerships and strategic alliances, formal hierarchical lines of accountability are more difficult to discern. Boards express their accountabilities through a diverse range of mechanisms, and the notion of an accountability matrix is probably more helpful than any hierarchical model in understanding the safeguarding accountability framework. Hierarchical models of accountability imply that at some level there is external authority from which the Board draws it mandate to act, and to which it must therefore answer. This 14 The governance of adult safeguarding

24 ADULTs SERVICES is not quite the case for Boards. It is more a question of the Board engaging in other forms of accountability: explanatory accountability (owed to those to whom one s actions must be justifiable) accountability with sanctions (to those who have the power to overrule) responsive accountability (to those who should be consulted but not necessarily obeyed). Some forms of accountability thus serve the function of scrutiny; others serve the function of developing the Board s activities in line with stakeholder needs and priorities. Board documentation does not distinguish between these, but participants expressed concern about the challenges of multiple partnership engagement in relation to the question of who takes responsibility for what; if everyone has a hand in everything, and the boundaries are not clear, there is a danger that some things don t get picked up by anyone. This potential is perceived as being exacerbated by a lack of statutory duties. Additional complicating factors were seen as: the parallel systems for accountability that exist in governance arrangements for safeguarding in health settings, and in clinical governance arrangements, from both of which there was perceived to be too large a gap conflicts of interest can arise, when a Board member is also part of the scrutiny and accountability arrangements for the Board. This arises, for example, in relation to the director of adult social care, and to elected members if they are members of the Board. A further important aspect of accountability is that owed to the least powerful stakeholders in safeguarding people at risk and their carers. A key mechanism for empowerment is strengthening the accountability arrangements between the Board and those whose wellbeing it is working to protect by developing reporting and representation arrangements. The second form of accountability is that owed by members to the Board. This has been addressed in part in an earlier section of this summary (that relating to membership). But one key issue for resolution is the nature of the authority that the Board holds in relation to its members. The range and scope of Boards powers over decisions are not commonly spelled out, although where they are, it is usually to specify that they are in fact quite limited; member agencies commonly retain the right to consider (and ratify or otherwise) their adherence to the Board s decisions. The Board s authority is in effect a consensual authority, exercised over its members through their agreement to grant its executive powers and be bound by them. Memoranda of Understanding created between Board members thus have an important function in codifying the permissions that member agencies accord each other. Concluding observations on governance A key question is to what extent governance mechanisms impact on the safeguarding performance of authorities. There is no evidence that particular forms of governance 15

25 lead directly to improvements in safeguarding, but there is some limited evidence to suggest that particular governance arrangements may be associated with strong performance as assessed by CQC inspection. The following characteristics are identifiable as present in reports on authorities who receive higher scores and positive review on the safeguarding element of inspections: strategic leadership from the Board, clear goals and vision clear interagency safeguarding procedures and consistent implementation well developed risk assessment and management processes staff knowledgeable and clear about their responsibilities good recording with precision in noting safeguarding interventions involvement of people who use services and carers in their own safeguarding good understanding of issues of capacity and choice good management oversight of practice widespread understanding of safeguarding across provider networks strong engagement from Cabinet and committees high level of senior representation on the Board independent chairing involvement of people who use services and carers in the Board clarity of governance and accountability arrangements dedicated resources priority given to scrutiny of safeguarding by the Overview and Scrutiny Committee evidence of strong partnership protocols between key partners evidence of strong links with other partnerships with strategies for community safety monitoring and analysis of activity strong performance management with evidence of effective challenge robust QA frameworks and means of embedded quality improvement strategic approach to training, underpinned by a competency framework safeguarding embedded within commissioning and contracting evidence of a strong information strategy and public awareness of safeguarding informative annual report. It is possible also to identify principles of good governance in other fields and apply these to benchmark the arrangements in adult safeguarding. Useful in this context are: a. a universal standard for governance (OPM and CIPFA, 2004), which prioritises six core principles (as shown here) b. addressing the additional challenge for partnerships of securing accountabilities between partners as well as between the partnership and other bodies (Audit Commission, 2005) c. standards by which to track Board performance, such as that offered in the 7S framework (Audit Commission, 2009) which scrutinises standards, systems, synergies, style, staff and skills, steering and sustainability (strategy) d. principles of good governance in children s safeguarding (NSDU, 2009), identified in evaluation of arrangements in Local Safeguarding Children Boards (France et al, 2010). 16 The governance of adult safeguarding

26 ADULTs SERVICES Performing effectively in clearly defined functions and Engaging stakeholders and making accountability real roles Developing the capacity and capability of the governing body to be effective Focusing on the organisation s purpose and on outcomes for citizens and people who use services Promoting values for the whole organisation and demonstrating good governance through behaviour Taking informed, transparent decisons and managing risk The governance literature suggests there is a need for further clarity about the role of local partnerships and how individual partnerships relate to each other and what their individual and collective lines of accountability are. Specific legislation that sets out for Safeguarding Adults Boards roles and functions, membership and accountabilities, might help to standardise policy and procedures, to hold agencies more easily accountable, to clarify responsibilities and to ensure participation in ways which statutory guidance, differentially binding on the partners, has not so far been able to do. Perhaps this explains why workshop participants were exercised by the question of the Board s authority; by some this was seen as the central question, but one which was not easy to answer. In some ways, the perceived looseness of the Board s mandates and the complexity of its networks leaves much to local discretion, but there was a sense of frustration that safeguarding was not securely tied into strategic local planning priorities other than by the tireless efforts of its champions, and is therefore vulnerable. In conclusion, drawing on the governance literature reviewed here, it is possible to identify some of the markers of Boards in whose features can be observed adherence to good governance principles. Thus Boards with strong and robust governance arrangements will show the following characteristics. These are listed within the themes used to report the research findings in this report, enabling the 17

27 evidence on which they are based to be verified from the corresponding sections of the report. Strategic goals and purpose Strong statements of principle: these would express core commitments to safeguarding, the values that underpin those commitments and the values that inform the means of achieving good safeguarding outcomes Explicit commitment to the multiagency nature of responsibility for and ownership of safeguarding Clarity of strategic goals: these would identify top-level outcomes sought by the Board Good environmental scanning: this would demonstrate sound awareness of the policy environment, awareness of new challenges and risks, proactive innovation in addressing these Definition of scope: this would include attention to different types of safeguarding activity, from preventive to reactive, from community to individual focus; and to the breadth of perceived solutions, to include attention social and environmental factors associated with abuse Structures Clear divisions of responsibility between Board, executive, operational group and sub-groups, all of which have clear goals and Terms of Reference (horizontal differentiation) Mechanisms to ensure vertical communication/coordination through the layers of the structure (vertical coordination) Structures (whether sub-groups or ad hoc working groups) that enable detailed work in specific areas to be progressed (vertical differentiation) Explicit linking between the work of sub-groups, ensuring that the work of one is taken account of in the work of another (horizontal coordination) Membership Evidence that agencies have entered into explicit commitments to the requirements associated with membership of the partnership, which are clearly set out Clear identification of the roles of different agencies and their contribution to safeguarding Clear membership strategy and rationale for inclusion Appropriate means of engaging with stakeholders not represented on the Board Clarity on how people who use services and carers are involved, and an involvement that permeates the Board and its structures Clear descriptor for the role of the chair, containing clear identification of role and functions, reporting and accountability mechanisms Detailed specification/regulation for the internal procedures of the Board, quoracy, meeting protocols, etc 18 The governance of adult safeguarding