Two adult safeguarding social workers will present two anonymised cases with the purpose of facilitating a discussion regarding the challenges and dilemmas involved in adult safeguarding, and how it can make a difference to people’s lives.
The first Experienced Social Worker introduced themselves, and informed the Panel that they had worked in the council Children’s department for three years before moving to the Adults team, and went through the details of the first case study.
The case study concerned a 90 year old resident (Resident A). This had been a complex case which involved the challenges of meeting Residents A’s wishes while dealing with issues of mental capacity and dementia, which had led to a decline in health. This case had been subject to an application to the court of protection, as the challenges had needed a legal framework.
In response to questions from the Panel about what could have been done to maintain Resident A’s independence, Members heard that the court could have listed the case and responded faster. Members acknowledged the difficulties in dealing with cases of hoarding, with experience of residents hoarding in their wards. A Member informed the Panel that work had been done with the Head of Public Protection to negotiate with fire services and get houses cleared while avoiding the courts, and suggested this for future cases. Members agreed that residents admitted to care homes could become institutionalised very quickly, and queried what other options, such as assisted living, had been considered to help Resident A maintain independence. The Panel learned that other options had been considered.
The Head of Adult Safeguarding and Quality Assurance highlighted the complexity of the case, with Resident A having the capacity to state that he did not want his family involved, and the difficulty of deciding when to proceed as normal and when to involve the courts. Involving the courts did not always improve the situation, as all decisions then had to go through the court process which reduced flexibility and the ability to manage the case.
Resident A had two social workers (one from the locality team and one from the safeguarding team) and had a good relationship with both; however, he would not take advice from either. The environmental team had talked to Resident A following complaints from neighbours about flies, but he would not let them into the property for an assessment.
In response to questions about how common this kind of case was, the Interim Service Manager stated at the last Croydon Vulnerability and Risk Management Panel they had attended there had been six cases, and five of these had concerned self-neglect or hoarding. The Breakthrough counselling Group Project (discussed at the January 2019 meeting of the Panel) had been helping residents identified with hoarding tendencies in collaboration with Mind. The Head of Adult Safeguarding and Quality Assurance informed the Panel that funding for this project over three years had been secured. In response to queries from the Chair about the limited number of residents who could participate at once, and the waiting list to join, Members heard that the approach had been to develop a variety of options to help those struggling with hoarding, such as work done with Clouds End, to ensure responses were as effective as possible.
When asked whether court cases often took this long to progress, Members heard that it varied, with a case that had been referred to court recently only taking a number of weeks. The Head of Adult Safeguarding and Quality Assurance explained that normally only ten cases went to court a year.
The Chair praised the work done on the case, and stated that they were heartened that ultimately Resident A was able to make choices about his care, to the extent which he was capable. The Chair stated it was difficult to know who was right in these cases, but appreciated that social workers did everything in their power to allow Resident A to make decisions.
The Head of Adult Safeguarding and Quality Assurance informed Members that there had been a multi-agency audit of self-neglect cases and the relationship with the Legal department had improved. There had been participation with huddles throughout the borough.
The second Experienced Social Worker introduced themselves, and informed the Panel that they had joined the council in 2008 as an assistant care manager; they had been sponsored to do social care training and had qualified in 2014.
The case study concerned a man with multiple disabilities (Resident B), requiring 24 hour care. Resident B had been living with their mother, younger brother and younger sister in a council property. Resident B had attended a specialist school. A referral had been received over concern of neglect, and the case had been referred for a Section 42 Enquiry.
There had been concern about neglect and the mental health issues of the mother. The situation had come to a crisis and the mother had been admitted to hospital, and had later been sectioned. Resident B was also taken to hospital, as they were found to be unwell; Resident B’s brother had been taken into foster care. This left a vulnerable 18 year old young person in the household who, in theory, did not meet the statutory criteria of either children’s services or adult social care. This person was also in the middle of their A levels.
After exploring a number of options, a place with a family with children of a similar age had been found through Shared Lives. The sister had been supported in applying to university and for grants to cover full time accommodation for the duration of their studies; there were fears that if the mother had been discharged she would have prevented the sister attending higher education.
The Chair praised the work done for the young person, and for not letting her fall through the cracks; the Chair stated that the cracks should not be there, and that work done with a multiagency and locality approach would help to close these.
The second Experienced Social Worker stressed that there had been a lot of consideration as to whether the response had been proportional, but that it had ultimately been felt that actions had been taken in everyone’s best interest. The multiagency response had been important and had a great impact.
Members agreed that the case had been very complex.