Adult safeguarding and homelessness: foundations for positive practice in safeguarding people who are homeless, 17 December 2020

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Transcript

Moderator: Thanks everyone. So, thank you for joining this morning. My name's Ade (ph. 00.14) Cooper, I'm the Care and Health Improvement Advisor at the local government association for the Care and Health Improvement Programme, which is supported by the association of directors of adult's social services and the LGA. We're here this morning to listen and talk about adult safeguarding and homelessness, foundations for practice. So, this is the first of a series of virtual seminars and it builds on word undertaken previously about adult safeguarding and homelessness. Some of you may have been involved during 2019, 2020, in four national workshops that we organised, adult safeguarding and homelessness through the Care and Health Improvement Programme and those workshops bought together people from a whole range of different organisations, different places, different experiences, to listen to people talking about and to discuss issues regarding safeguarding for people who experience homelessness, particularly those who are at risk of abuse and neglect, and the outcome of those four workshops was published in a briefing in March this year on adult safeguarding and homelessness, which Michael is going to talk about later on this morning. So, originally, before the COVID pandemic, what we had planned to do was to use the briefing to disseminate it to support further discussion and debate at a regional level but, obviously, COVID changed all of that, so from the beginning, in fact, from probably nearly two years, we've had an advisory group of colleagues who've supported this workstream in the CHIP programme and we talked to them about what would be most useful under the current circumstances, to take this work forward at this time, and in discussion with the group, we have planned a series of eight sessions based on themes, so each session has a particular theme, and today's session is about the foundations for positive practice.  

So, as well as Michael talking about the briefing that was produced earlier on this year, Bruno is going to talk about undertaking care assessments and planning for people experiencing homelessness. So, just Michael, going back to the previous slide, to reiterate what the objectives are today, and these are core to the eight workshops, or the eighth webinars, seminars, that we've organised. What we're aiming to do is, to bring together people working in services for people who are homeless or rough sleeping, to bring together people who work in safeguarding and adult social care, to better understand how to work to provide support and safeguarding for those people in our communities. As with everything that we do in the CHIP programme, these are about sector led improvement and we're about-, this is about learning from each other from good practice in other areas and from experiences that people have in these areas of work. We want to develop our understanding of this in order to produce a second briefing to support you working in those areas and to be informed by what's happened this year with the impact of the pandemic, because we know that it's drastically changed the ways in which people have worked. So, hopefully that's what you're expecting from today and it's no surprises and welcome to-, because I understand, I can see people are still joining, so welcome and good morning and I hope that you really find the session useful. What we're going to ask you to do is to put your questions through the Q&A function and-, and (mw 03.56) colleague will be pulling those together and I will then be managing the questions with the speakers today, thanks, so put-, put your questions in the Q&A function.

F: Wait a minute.

Moderator: Okay. So, I'll just say that the slides that you see today will be available on the LGA website within a couple of days, so please feel free to use them. Excuse me, so this is the structure today. Michael (mw 04.35) is going to speak first, we can have-, we'll have a session after that with questions and answers for you to engage, but also tell us about your experiences and any areas of good practice that you would like us to know about because, as I say, we're trying to pull that together through these workshops for-, for the second briefing. We've put in a break for coffee, comfort break, and then Bruno's going to talk about care assessment and safeguarding planning and then we'll have a session with Bruno where he can answer questions and then I'll talk about what's happening after the-, in the next seven sessions after this. So, I think if that's okay, what I will do now is hand over to Michael (mw 05.21) to present the briefing. Michael, do you want to introduce yourself and I'll hand over to you and put myself on mute, is that okay? Thank you.

Michael: Yes, that's fine thank you. Thank you, Ade, and good morning everybody. It's fantastic to see so many people in the virtual room, so that's-, that's really great and thank you for your interest in and support for this work. So, my name's Michael Preston-Shoot, I'm now an independent adult safeguarding consultant, I chair two safeguarding adult boards, one in Brent and one in Lewisham in London, and I write safeguarding adult reviews and periodically work with the CHIP programme on-, on projects including this one, and what I'm going to do is to set the scene, essentially, for the eight workshops by summarising what is in the briefing, which is on the LGA website and beginning to add to it because, as Adi has highlighted, one purpose for these eight seminars is to collate the best evidence that we have of good practice when working with people experiencing homelessness and to produce an updated briefing in March, April 2021. So, do begin, in line with making safeguarding person, I'm going to start with two messages from-, from people who were the individuals on whom a safeguarding adult review focused, a message from Helen and a message from Terence. Helen's case, in fact, does not involve homelessness in the sense that we will be talking about it in the eight seminars, although there were occasions when, because of her disability, she either could not access the accommodation which she had, or when inside her accommodation, she could not leave it, because of the disabilities that-, that she had, and her quotation reminds all of us of the importance of seeing the world from the perspective of the individual that we are working with. Helen was a physically disabled woman, she was a mother, she had a son with disabilities and the case highlights the importance of the accessibility of the accommodation, which we are fortunate to have, it also highlights the importance of thinking family and the case highlights the importance of the links between children's social care and adult's social care and the damage that can be done to people's lived experience when those linkages are not working effectively.  

There is a link, too, in this to what Bruno will go on to talk about later, about the importance of thorough, robust and routinely reviewed assessments. So, a message from Helen and then a message from Terence, which you can find at the beginning of a thematic review, excuse me, done by Worcestershire Safeguarding Adult Board, published recently, a review of a number of cases of people experiencing homelessness and the review starts with a direct quote from Terence and, indeed, in the-, in the body of the review, that direct quote is amplified with other things that-, that Terry said wrapped around what was known about his experiences, and as you can see here, excuse me, Terence is reminding us about the importance of relationships, he is reminding us about the importance of the humaneness and humanity and carefulness, careful in the hyphenated sense of that word, the carefulness that we demonstrate in relation to the people with whom we are working. The eighth of the eight seminars will include a number of presentations from experts by experience and, indeed, I intend that all of the seminars will be interwoven with the direct experiences of experts by experience and I've no doubt that Bruno will touch on that too in his presentation. So, in line with making safeguarding personal, it's important to begin there. Continuing the theme of the voices of lived experience, it's important to recognise that there are many routes into-, into homelessness, it is something that from which all of us are perhaps just one or two steps away and-, and hasn't the pandemic highlighted that? Particularly for people in sectors like hospitality. So, it's important to see the whole person in-, in their situation, not simply to respond to that little bit of a person's needs or experiences that fall within the usual remit of the service that employs us, it's important to understand trauma and loss and bereavement when-, when that is part of a person's lived experience, and the importance of recognising that the solutions which we all use to address the challenges that-, that we face, that rather than simply focusing on those solutions, it's actually focusing on-, on what those solutions are-, are an attempt to cope with and attempt to manage, so a reference to the causes that underline how we see a person in the here and now, today. 

That was brought home to me when I was fortunate, honoured indeed, to write a review for Tower Hamlets Safeguarding Adult Board on the experiences of two women who were homeless and, in particular, how much I benefited from the wisdom, there perspective, the contribution of Ms I's partner, who was himself someone who had lived experience of multiple exclusion homelessness and-, and he really brought home to me that very often what we see people presenting with are attempted solutions, however dysfunctional we might think they are, attempted solutions to the challenges that they have experienced throughout their lives and in relation to (inaudible 13.07) that went all the way back to childhood and her partner had some knowledge of what she had experienced, but also knew that there was so much that she had not been able to share with him, because of how painful it was for her and, as you can see there, whether it was in relation to alcohol abuse, substance misuse more generally, an inability to hold down tenancies, or indeed, to live within temporary accommodation and hostels. There were time when she could not, even with some wraparound support, including that from her partner and from third sector agencies in particular, there were times when she could not manage, because things bubbled up, to use her partner's phrase, and what he felt was, that that was not fully appreciated by some, at least, of the services and the practitioners surrounding Ms I. To help us, there are some definitions of multiple exclusion homelessness and, indeed, some definitions of care and support needs and some guidance about the interface between housing and adult social care and, again, I'm sure when Bruno is talking about assessments and pathways into adult safeguarding, Bruno may well come back to the guidance that is available about the interface between homelessness and adult social care in particular, but equally also the helpfulness of definitions which Bruno and others have-, done so much to-, to highlight.

So, we do have a definition of multiple exclusion homelessness in order to reinforce that for many individuals with lived experience of homelessness, that is accompanied with a number of other challenges which they are having to negotiate, not least challenges relating to their mental well-being, their physical well-being, their use of substances, and the definition really enforces what I think we know about best practice, which is that you have to see the whole person and you have to respond to the whole person's needs and that requires a multi-agency, multi-disciplinary endeavour, rather than being tempted to hide behind threshold criteria and eligibility criteria established by- by single services. And definitions which I'm sure Bruno explicitly or implicitly will highlight in his presentation to follow, but just to remind us all that the statutory guidance that accompanies the Care Act, the regulations that accompany the Care Act, do provide a definition of care and support needs that include physical or mental impairment or illness and that that can arise from substance misuse, as well as from other causes. The statutory guidance does contain references to the interface with housing legislation, again, recognising that this has to be a whole system response and the statutory guidance and the Care Act itself reminds us that, in certain cases, a Human Rights Act assessment is also part and parcel of the necessary response, particularly from adult social care and a reminder, too, in the Care Act itself that where a duty to meet eligible needs does not arise, there is in fact a power to meet needs, which each local authority adult social care department should explicitly consider. Something which was not in the first briefing, which illustrates the importance of an-, an updated briefing at the end of these eight seminars around March, April 2021, is the landmark study, the first national analysis of SARS in England. It is on the LGA website, it's available to read on the web, but also to download as a PDF version and every safeguarding adult board has been sent a copy through business managers and independent chairs. 

You can see that there were 231 SARS in the sample. You can see that there were 132 safeguarding adult boards at the time, 129 of them in fact submitted information about completed or-, and published or unpublished reviews. Interestingly, there were 25 SARS in the sample that contained references to homelessness, the majority of them published, and I think this highlights that central government was wrong to say that safeguarding adult boards had not focused on homelessness as part of their statutory review responsibilities, 25 SARS in the sample containing references to homelessness. You can also see that self-neglect was the most prominent type of abuse and neglect reviewed in the sample and, obviously, there are links between self-neglect and homelessness, just as there are links between homelessness and substance misuse and you can see the number of SARS that contained references to alcohol abuse and dependence. Some of these reviews that I'm listing on this slide and indeed the next one, so that you can refer to them if you are interested to see what emerges in learning from safeguarding adult reviews, and to highlight the fact that there are many routes into homelessness. The Bexley Safeguarding Adult Board review and case of AB is in fact a case of domestic abuse amongst other things and how the victims of domestic abuse can find themselves homeless. The Brighton and Hove case is in fact the one and only case in the sample that related to somebody who was transgender and it highlights hate crime and discriminatory abuse as a potential route, or an actual route in fact, into-, into homelessness. And the Newham case of-, of Mr YI demonstrates how challenging it can be for social workers and other practitioners to find a local authority that is prepared to accept responsibility for a homeless person when they cross geographic and political boundaries. The reviews, some more recently published since the first briefing was produced, that highlight no recourse to public funds as a significant challenge that continued to highlight the importance of breaking down the revolving door between mental health and substance misuse services and responding to the whole person, rather than responding through our silos.

A case in Cornwall, just published in fact this month, that highlights the-, the challenges for practitioners of deciding when a person's autonomy and self-determination should in fact give way to a duty of a care and a duty to protect and the importance of references to-, referrals to the court of protection in such cases. Multiple routes in homelessness, the Milton Keys SAB, a former care leaver highlighting the importance of transition and the importance of linkages between children's social care and adult social care. So, there are a range of reviews that demonstrate multiple routes into homelessness and that continue to illustrate good practice and practice shortfalls. And in addition to the reviews, there are research studies which highlight what is needed by way of a good practice response, so the importance of wraparound health and care demonstrated by the Kings Fund study, the reference for which is-, is-, is there, just as one example and the reference also to the national analysis, which is referenced at the top. So, how do we need to respond and-, and how is this reflected in the eight seminars, of which this is the first? Well, the answer is that we need to focus on five systems. We need to focus on direct work with the person, which is why I began with the two quotes from Helen and from Terence, in order to illustrate the importance of making safeguarding personal and making sure that the person with lived experience is at the centre of the work that we do. The importance of the organisational context, I've-, I've mentioned several times now the importance of breaking down eligibility criteria and thresholds in order to ensure that there is a whole system response to the needs of particular individual and part of that whole system response is the team around the person, the inter-professional and interagency work that takes place directly with people like Helen and-, and Terence, and all of that overseen by a safeguarding adult board working in conjunction with homelessness reduction boards, health and well-being boards, community safety partnerships and other boards and partnership bodies established in the local authority and-, and with partner agencies, the importance of safeguarding adult boards leading on a whole governance conversation, and all of that located in a legal policy and financial context and, again, the pandemic has illustrated how influential the outermost domain can be, for example, through the Everybody In initiative as part of lock down one and the wraparound support that was provided when people were accommodated in hotels and elsewhere, rather than leaving them on the streets in the midst of the first wave of the pandemic.

Where there is a political will and a financial will to invest in particular areas, as there has been in relation to people experiencing homelessness during the pandemic, it is possible to see how we can more effectively address the challenges that are faced by people who are homeless. The next few slides I don't intend to talk in detail, you will have the slides on the LDA website as Adi illustrated within 48 hours from this particular seminar, but they just reinforce many of the components of good practice in relation to people experiencing homelessness. In the 25 SARS in the national analysis, there were fourteen references within those reviews to good practice. Good practice highlighted through the rapport that was built with people who were experiencing homelessness, the degree of humanity that was shown towards people, the support that was offered, the use of referrals to different agencies, the use of emergency and-, and-, and temporary accommodation. So, references to good practice illustrating that it is possible for people to work effectively and directly with people experiencing homelessness and indeed to be part of a whole system response. Organisational factors, a key component of the framework for best-, best practice and interagency cooperation, and I've highlighted much of what is in these two slides. The second of the eight seminars will in fact be on commissioning and will illustrate what is on the bottom right of that slide, the importance of joint commissioning to achieve integrated working and an integrated architecture of services to promote integrated working with the team around the person and indeed co-location was quite often highlighted by safeguarding adult reviews as an example of good practice, or where co-location did not exist, an example of a practice shortfall. There were 42 references in the national analysis to practice shortfalls in relation to people experiencing homelessness, delayed or missing assessments of risk, mental capacity, or care and support which, again, highlights the importance of Bruno's contribution to follow today, a lack of use of-, of different legal rules to find ways forward for people experiencing homelessness, uncertainty about referral pathways, particularly into mental health and or substance misuse services, people being discharged from prison or from hospital to no fixed abode without use of the Homelessness Reduction Act 2017 and the duties therein.  

And then the fourth of the domains, the importance of SABs exercising oversight, governance oversight of adult safeguarding and-, and homelessness. So, as I've already highlighted, the importance of SABs initiating where it has not already happened, a whole system governance conversation to determine where governance responsibility for services in relation to multiple exclusion homelessness, where that governance sits and if it doesn't sit with the safeguarding adult board, how the SAB and its statutory partners can contribute to that governance oversight, and then in relation to the interface between homelessness and adult safeguarding, the SAB exercising its statutory mandate, perhaps its leading statutory mandate, to seek assurance relating to how effective or otherwise services are in their responses to people experiencing homelessness, and if cases meet the mandatory or discretionary criteria for safeguarding adult reviews, then ensuring that that review process is timely, robust, thorough and results in clear outcomes of service enhancement and service improvement. If you're familiar, as I hope you are, with statutory guidance in relation to adult safeguarding, then you will know that there are six key principles, empowerment, prevention, protection, partnership, proportionality and accountability, and Adi and I have had several conversations about how these six principles might be applied to the interface between adult safeguarding and multiple exclusion homelessness. So, this slide presents our best effort to date to summarise how these six principles apply in relation to adult safeguarding and multiple exclusion homelessness and I would very much appreciate your feedback, not just on the briefing as a whole and in relation to these slides, but your- your feedback particularly about how we might amplify those six principles, so they become meaningful in-, in our everyday practice.

And I've talked about the importance of the fifth main, the legal policy and financial context, and it really is important that we speak into that legal policy and financial context whenever we have the opportunity. We know, for example, that there is still considerable uncertainty about when it might be lawful under the Data Protection Act to seek, or indeed to share, information. The act is not and should not be a barrier to sharing information to safeguard an adult at risk. We know, not least from safeguarding adult reviews that there remain considerable challenges in understanding and implementing the Mental Capacity Act and particularly understanding the five principles, the importance of building into assessments and the assessment referencing exxecutive functioning and the importance of understanding the interface between the diagnostic test and the functional test in sections two and three of the act. There were very few recommendations in the SARs in the national analysis about the legal policy and financial context within which adult safeguarding and indeed homelessness reside. And as I've highlighted, the pandemic is not just a crisis, but is also an opportunity, we have demonstrated that where there is a political will and a-, and financial investment, it is possible to make progress with respect to what might be termed in inverted commas a wicked issue and we have demonstrated what is possible when there is a whole system wraparound support approach to people experiencing multiple exclusion homelessness. So, that brings me to a conclusion with a number of questions that occurred to me when I was thinking about what to say today and I shall leave this slide up for the Q&A session before I take my slides down and invite Bruno after the comfort break to share his slides. So, enough from me and I look forward to hearing what is in the Q&A and indeed you can contact me directly, my e-mail address will be on one of the slides that you will see when they're loaded up onto the LGA website. So, if there are examples of good practice, if there are concerns about practice shortfalls, if there are issues that you think we should conclude in the second briefing, if there are case studies, particularly of good practice, that you think it is worth highlighting in-, in the second briefing, then please do share those with me subsequently by e-mail. So, thank you for listening and I'll hand back to Adi and (mw 35.23) to take us through the Q&A.

Moderator: Thank you so much, Michael. So, there's some really interesting questions that have come through the Q&A. So, the first one is about human rights assessment and how might a human rights assessment react for the need to support for homeless people with no recourse to public funds, and certainly that came up through the first four workshops we held last year as a really key area of challenge, in terms of I suppose levels of legal literacy, but I wondered if you could speak a bit about that whole area, if that would be okay.

Michael: Okay, thanks, Adi. In fact, I think it is the fourth seminar from memory, I hope my memory's accurate, but we will have input in that seminar from Henry Sinclair-Miller, who I have heard speak on several occasions in relation to people with no recourse to public funds and-, and how services should be responding within the law, and also an input from Laura Pritchard-Jones, who's a lecturer in law at the University of Keele, not far from where Bruno works, and she too will be focusing on this area, as well as legal literacy more generally. You'll also find in the briefing that is on the LGA website on adult safeguarding and homelessness a section on law and legal literacy and that includes how the law may be used, including the Human Rights Act, in order to try to meet a person's needs. Briefly, in relation to human rights act assessments themselves when a person has no recourse to public funds, or when a person might have recourse to public funds, but has been assessed as not eligible for-, for example, care and support needs and it's possible Bruno may touch on this later this morning, it is essential to conduct a human rights act assessment with a particular focus on article two of the European Convention on Human Rights, The Right to Life and article three, which is The Right to Live Free of Inhuman and Degrading Treatment, and it is important, in that assessment, to ask the question whether if no service is provided, the impact on the person's physical and mental well-being is going to be so significant that it is essentially an inhuman and degrading response from the state. So, that's the importance of focusing directly on human rights. What has struck me as a SAR author recently is that whilst some adult social care practitioners and operational managers may be aware of the importance of focusing on human rights act assessments, they're not entirely clear how to do so and that practitioners and operational safeguarding managers in NHS trusts, for example, have said to me that they weren't even aware that it was a responsibility on the state to ensure that article two and article three convention rights were met, even in respect of people with no recourse to public funds. So, I would recommend that you read the section in the briefing on-, on legal literacy and perhaps also sign up for the seminar when Laura and Henry will be speaking explicitly about no recourse to public funds in the context of legal literacy more generally.

Moderator: Thank you, and we recognise this as a significant area in terms of the programme. The next question I think is quite familiar, which is in relation to making safeguarding personal and that dynamic, so the questioner said that they agree that it's not-, it's about respecting the wishes and feelings and views, but also following freedoms and how isn't it contradictory? And I think that tension around making safeguarding personal and how we apply it in areas where someone's expressed wishes maybe not considered in their best interest is a really tricky area for all practitioners and I imagine Bruno will talk a bit about this, but do you want to make any comment on that, because it features quite heavily, particularly in safeguarding adult reviews, around how that tension is-, is-, or that-, that dilemma and it is an ethical, moral dilemma, is managed?

Michael: Yes, and actually the partner of Ms I, whom I referenced earlier in-, in my presentation was very clear that services faced a moral question in relation to Ms I, his partner, and that was, was she making a lifestyle choice that was capacitous, was she exercising her autonomy and self-determination, or in fact was se behaving in a way over which she had no choice at all, because of her adverse life experiences going all the way back to childhood and that, in that sense, she was not making a choice, she was in a sense compelled to behave at particular times in particular ways and should the state not have intervened more directly in-, in Ms I's life? He recognised that that was a moral question, he recognised it was a-, a challenging dilemma that practitioners faced and indeed he recognised that he also faced when we was trying to work out how best to support a person he loved. The case of Jack, which I put up as one of-, of the SARs I think illustrated this very well and it's just been published on the Cornwall SAB website. It is a person who was itinerant all his life, sometimes living in tents, sometimes living on the street, sometimes living in various forms of temporary accommodation in-, in-, in many, if not all, of the four nations of our disunited kingdom and, at the age of 80, he was still living in that particular way, but his physical disabilities, including sight loss, were making it increasingly difficult for him to himself safe in the way that he had been doing throughout his adult and indeed adolescent life, and practitioners wrestled with should the state now intervene?

And in the end, a senior manager in adult social care determined that in fact the state should intervene and the route through to intervene was in fact a referral to the Court of Protection to see whether the high-, whether the Court of Protection judge, on the basis of the evidence, agreed that Jack did not have capacity any longer to determine how he should live and what care and treatment he should receive for his various disabilities and the choices that he was making in relation to evident risks including safeguarding risks, and in fact the Court of Protection, on the balance of the evidence in that case, deprived Jack of his liberty and placed him in-, in a nursing home. And as practitioners recognised in learning event conversations I had with them, this was a case that brought home the Lord Justice (mw 44.05) quote that many of you may be familiar with, what good is it making somebody safe if we merely make them miserable? And practitioners and managers across the different health and social care services were wrestling with that dilemma, had we made him safe but made him miserable, or actually had we exercised an appropriate duty of care and a duty to protect, because he was either no longer capacitous, or he-, he was, in a sense-, he-, we had crossed a line and, because of the right to life and the right to live free of inhuman and degrading treatment, the state had a positive obligation to do what it could to enhance Jack's mental and physical well-being. Yes, these are challenging issues, I think what the SARs highlight is the importance of multi-agency and multi-disciplinary conversations and ultimately, in very complex cases, referral either to the High Court for the use of its inherent jurisdiction, as in the Southend-on-Sea versus Myers case, or referral to the Court of Protection, as indeed happened in Jack's case.

Moderator: Thank you, Michael. I think it's a really good question, because it gets to the heart of the real dilemmas of practice in this area. The next question is interesting, because I-, I don't have an answer for this, but you might. A colleague has said that we have a SAR where someone was placed in custody, as there was no accommodation available for them and is that something that you've come across?

Michael: Yes, in-, in-, in terms of somebody being held in-, in-, in police cells, because there isn't an available section 36 suite with a vacant bed. I've certainly come across that kind of case if-, if that's what is in the back of the mind of the person who asked the question. So, a shortage of section 136 suites and section 136 beds has-, has come up. I'm also aware that, even when people are placed in an appropriate location to meet their mental health needs, there isn't always available immediately the necessary psychiatric and medical team to conduct assessments, so people are being held, but not being treated in a timely way, that's also come up in a number of SARs with which I'm familiar. I'm not sure if that gets to the heart of the question, but that's what immediately occurred to me, Adi.

Moderator: Thank you, Michael. So, the next question's interesting, because it's based on the recent Oxfordshire thematic review, which you and I did. So, it showed that a lot of services were doing their own work, but appeared to miss overall insight, sorry, overall oversight of the work of-, to support homeless persons, and so do you think an allocated support worker who reaches across agencies would be a route to follow as a mechanism for addressing that particular issue around lack of overall oversight in terms of support to people?

Michael: Yes, is the short answer. The slightly longer answer would be that there is increasing research evidence and SAR evidence that co-location helps. So, for example, the community psychiatric nurses as part of a police team, housing officers located in acute trusts and in mental health trusts, housing and health personnel located within prisons when-, in order to address the needs of people approaching parole and being let out on licence and so forth, so something around co-location. We know from SARs, don't we, that the importance of nominating a lead agency and a keyworker is absolutely essential, where the role of the keyworker is to coordinate the work that all of the services are doing, so that we've actually got a coherent and a cohesive system. So, a slightly longer answer, but yes and that's what we found in Oxfordshire.

Moderator: Absolutely. I'm going-, the-, the next question is quite-, is quite short. Do you think there's a gender bias in supporting homeless people? I suppose the evidence from the safeguarding adult reviews and the-, the knowledge base is that, often, the needs of female women who are homeless may be overlooked in the ways in which services-, that would be my perspective from sort of a removed, slightly more removed, but how would you address that?

Michael: I think there is some evidence that there is a gender bias, that there is some evidence that women who are homeless, particularly women who are homeless who also misuse substances, just like Ms H and Ms I, I think there is some evidence that that is seen in a-, in a way as being much more abnormal, if I can use that word in inverted commas, than-, than would be the case in relation to-, to men. I think that there is a challenge that we all face in relation to unconscious bias generally, so alongside gender, and I'm grateful for the person who's-, who's highlighted this, alongside gender I also think we have to include ethnicity and-, and the fact that very often we are not giving sufficient focus to the impact of a person's race, culture, religion, language, ethnic heritage, we are not giving sufficient consideration to that in how services respond, and just to give one example in relation to ethnicity, I have-, I'm shortly completing a review where one of the individuals involved was described to me as Turkish Cypriot, in fact he isn't Turkish Cypriot, he is Roma Cypriot and-, and when I was talking with people who know about Cypriot communities, they were telling me about the additional discrimination across Cypriot communities that people who are Roma Cypriot experience. In relation to gender, in the same review, one of the cases involved a woman who was homeless periodically who also misused particularly alcohol, there were steps taken to protect hr from financial abuse and from sexual exploitation in the temporary accommodation in which she was residing. Those efforts protected her to a degree, but perhaps on reflection when I look at the case, there wasn't the wraparound support that was really needed to safeguard her and there were occasions when there were missed opportunities to make adult safeguarding referrals in relation to how she was found and where she was found on a number of occasions. So, yes I think there is a challenge about unconscious bias, particularly in relation to gender, but also in relation to ethnicity.

Moderator: Thank you, I think that's a really useful question to get us to think about what-, what's not there, as well as what's there. The next question is about presenting an assessment, and apologies to the person who raised it, but I'm going to hold it over til after Bruno has spoken, because I think it will be helpful for both of you to respond. And the final question, very briefly before we stop for a break, was-, is about how do we overcome fears that some individuals have around social services, due to their negative childhood experiences and I think that can apply as well to the second half of this afternoon-, this morning's session around how do we manage, particularly when we're trying to engage with people when there's resistance, which is perceived as a resistance or non-engagement, but actually is a result of trauma, or experiences with not just social services, it could be the police, whatever, institutional experiences people have had that have given them a very negative response. So, just a very brief comment on that and then I think I'll save the rest of the questions to the second Q&A time and ask both you and Bruno for them respsonse.

Michael: Yes. I mean I think this applies as much to cases of self-neglect and no doubt other forms of abuse and neglect as it does to people experiencing homelessness. I think we have to reach out, so outreach is an important component. I also think that we actually have to acknowledge that we are part of a system that from time to time will have failed individuals, will have misunderstood individuals, and I think we have to be very clear about that and I think we also have to demonstrate through our behaviours, through our attitudes, through our approaches, that we wish to be part of the solution, we do not wish to be part of the problem, but I think we do have to recognise that-, that-, that people's fears about losing control, about being stigmatised, about being abandoned are-, are very real and are perfectly understandable. So, I think it starts with recognition and I think it also starts with outreach.

Moderator: Thank you for that. I'm going to now just say we are having a break. If people could come back at ten past eleven. I know there are a couple of questions that haven't been addressed, but I'll bring them to the second Q&A session and look forward to seeing you promptly at ten past eleven. Thank you so much, Michael, for the first half of the session this afternoon and we'll see you back in fifteen minutes. Thanks. So, welcome back everyone. Thank you for coming back for the second half of the session this morning. Bruno, I'm going to ask you to take us through the next half of this morning's session on understanding care assessments and safeguarding planning for people experiencing homelessness. So, over to you. Do you want to introduce yourself? Bruno's been key contributor to this work of the last couple of years and in particular around the really practical application of good practice in terms of safeguarding people and homeless, so I'm really pleased to have you on the session today, Bruno. I'm going to hand over to you, so similarly to the first half of this morning, if people can put questions in the-, in the Q&A and then we'll try and manage that through to both yourself and Michael can contribute as well after you've done your presentation. So, I'm just going to hand over to you, Bruno, and thank you for joining us this morning.

Bruno: Brilliant, thank you Aid, and thank you Michael as well for setting the scene. Yes, it's always very pleasing to-, to be able to join these things and it's equally really pleasing to see so many of you signing up to this-, to this workshop and undoubtedly the others that are to follow. So, my name's Bruno Ornelas, I'm the head of safeguarding for a National Lottery funded project, which is part of the Fulfilling Lives programme, supporting people experiencing multiple disadvantage and I'm also the head of safeguarding for an organisation called Bright Futures, which is based in Stoke-on-Trent. So, for the next 25 minutes or so I'm going to talk to you and share with you my suggestions for care assessment and safeguarding planning. So, this won't be about understanding necessarily what care and support needs are in the context of homelessness, because everyone will present with a unique set of circumstances, a unique set of configurations and, you know, which is often determined by doing an actual care assessment. So, I won't be telling you what those care and support needs are because, you know, it's-, it's very difficult to know, again, because everyone is unique in that respect, but the focus will be on understanding the assessment itself and getting to a point of an assessment in the first place. So, if you like, it's the work, or-, that you all need to do as practitioners before an assessment can actually take place and it's that kind of homework, if you like, that you all need to go over to really make sure that you can, you know, work towards the involvement duties of-, of getting that person involved in the assessment in the first place, because we know that things like-, from safeguarding adult reviews and what it's telling us that there are difficulties and challenges in acknowledging care and support needs in the first place.  

So, we're going to look, have a practical look, at how to do this stage, but to assure you as well that what we're going to do and what I'm going to do and what I've built into this presentation are that the suggestions that I'm going to be making, all these foundations for positive practice, I'm going to put them on a legal footing, so that it's going to be drawing on the primary legislation, which is the Care Act, but also the statutory guidance. I think it's really important to do that, so that there is an understanding of how the Care Act itself facilitates engagement, even with groups of people who have perhaps never fell under the remit of adult social care historically, and to-, to kind of relay to you that there is an absolute permission from that kind of legal perspective that even the most hard to reach groups, as it's often called, can actually in fact be reached and assessed and then their care and support needs actually determined. So, I'm hoping today will give you new ways of working with the Care Act and its guidance and perhaps some ways you haven't considered before, or at least act as a reminder as to some of the aspects of social care law within the Care Act that actually facilitates positive practice. Often you'll see from safeguarding adult reviews sometimes this is referred to as legal literacy and there's going to be a specific workshop on that, but what I am really going to try and do here is connect these good practice suggestions with the relevant aspects of statutory guidance in particular and the presentation, as you can see here from this slide, is going to be divided into two sections, one around the care assessment process which you'd find under section nine of the Care Act, and then moving onto protection planning, which is sometimes well suited under a section 42 enquiry, but again, there are alternative risk management pathways as well and not necessarily everything has to sit under safeguarding, and of course you'll probably be aware there's an overlap sometimes between the two routes, the section nine and section 42.

So, let's look at what safeguarding adult reviews have told us about acknowledging care and support needs and I've unpicked this a bit to kind of press upon-, and I think this will probably appeal to some of the questions that are actually getting asked in the Q&A, but just start with a basic reminder that assessment duty is based on the appearance of care and support needs and not necessarily is it about identifying and defining those care and support needs right from the very start. So, here the specific wording of the Care Act can really release some potential and we know that the threshold is relatively low for triggering the assessment duty. So, why do there exist challenges in acknowledging care and support needs? From what I've found and from reading safeguarding adult reviews and the literature, what we tend to see is that there is a tendency to confine homelessness to just a housing issue and Michael touched on this earlier, and a failure to recognise the relationship between different needs and those needs also include things like gender and ethnicity. One of the ways to perhaps think about this, if you're interested in knowing more, is to have a look at things like intersectionality, so that-, that's an academic term that was coined to-, to describe an experience of overlapping areas linked to gender and linked to things like ethnicity as well. So, all of those are contributing factors, but here specifically what we're looking at is the relationship between housing and adult social care and these are and can be inextricably linked, so if the only way to meet somebody's social care outcomes is by providing them housing, then clearly-, and, you know, and of course we know that housing duties trump Care Act duties and that's what you'll find under section 23, but very often, and not in all cases, there is a relationship where both social care and housing needs to go hand in hand. We also see that referrals, so these are-, it's very unlikely that somebody experiencing multiple exclusion homelessness has self-referred to adult social care and we know that the referral will often come sometimes from community based services that maybe work in homelessness and they've made those referrals, but what we're seeing from safeguarding adult reviews and also from my own experiences is that referrals and the assessments tend to focus on securing services, so the first initial conversation is about what's available by way of resources.  

Then what happens with that is that we make a series of assumptions about what we think the person might need, but we need to remember that the point of this is about focusing on understanding and defining needs and that's what the care assessment is about and we need to link that to the person's ability to achieve against those ten areas tat we find in the section nine care assessment process. We also know recently, from the ombudsman, about adopting a hierarchy of needs approach, this is when we perhaps attach more weight to a particular area and, you know, and we forget about the housing related outcomes within those ten areas which there are, so there are two housing related outcomes, and all areas need to be assessed equally in that respect and, again, this was a recent ombudsman report that reminds us of-, of how to do that stage. And statements, again, in practice that start with we don't provide X, Y or Z, so we don't have services for this and we don't have services for that, or they won't meet the criteria, or otherwise signposting people back to services that may have-, maybe haven't worked for them in the past and without carrying out any further enquiries or checks. So, again, this is not how to do an assessment, so these initial conversations, this is what I urge everyone to guard against, that we're focusing on determining and understanding needs and then after that is when we understand which of those needs are eligible to be met and how those needs could be met, but in the very first instance it's really, really important to understand and define those actual needs. And then, you know, taking what people tell you at face value, you know, we've heard from Michael earlier on that people are often in this survival mode and survival functioning and that you may hear things, you know, people saying to you if you get to a pint of assessment, you've engaged with the individual person, they'll say to things like-, things like, 'All I want is a flat', John said, and then your temptation could be sometimes to say, 'All he says he wants is a flat.' So, this is not working curiously with there person's expressed wishes, or otherwise being person-centred, what it is is paraphrasing what they've told you, so it's absolutely fine to be professional and curious, as well as, you know, taking a level of health scepticism about what people tell you.  

So, what do we do when people say things like they don't engage, or refuse-, the person has refused an assessment, or I can't get hold of them? These are commonly heard phrases that can sometimes lead to tensions on the frontline across different sectors. So, let's look at involvement, so we're trying-, this is the pre-work before the assessment actually takes place and this is what the guidance tells us about involving the person and you-, you all know this and you'll be well-versed in terms of involvement, we know it's about putting people at the heart of the assessment process, but it also reminds us that-, about the person's rights to have somebody involved in that assessment process and it doesn't necessarily have to be a formal carer, or an informal carer, but anyone the person has requested. So, it's really important as well, from agencies that are referring into that adult social care, to kind of inbuild these things into the referral itself, you know, what kind of consents have you sought from the person to perhaps get you involved in that assessment process? And building these things early into the referral as to-, and that-, that can help avoid delays later down the line. Equally important for any assessor is recognising when you need help, this is a key component of positive practice and that you have known-, we often hear about professional curiosity, or concern curiosity, but it's just as important knowing what to be curious about. So, if you don't have the knowledge as to where to apply your curiosity, then you can absolutely co-opt in other services and agencies to help you determine that. So, what we see in the statutory guidance is where the assessor does not have the necessary knowledge of a particular condition or circumstance, which could be homelessness or multiple exclusion homelessness, then involve someone, consult-, or consult with someone who's got that relevant expertise, it's absolutely fine and it's giving you permission to do that to help you objectively define what somebody may be going through.

So, there was a question I saw earlier in the Q&A about, you know, not involving sometimes the homelessness sector or housing professionals and often-, and this comes up, again, in safeguarding adult reviews where some sectors feel they've been left out of safeguarding processes or care assessment processes, but here it is, here's the absolute permission to involve that kind-, those that you may deem to have the relevant expertise. And how this will help you is to then know what sorts of questions to ask the person based on their condition or circumstances, so you can interpret these things in context and a person with relevant expertise can be considered somebody who, either through training or experience, it doesn't necessarily have to be a registered professional, and acquired through knowledge. And you will find, often in your areas, homelessness organisations that have been doing their job for a very, very long time and are often quite regularly part of your homelessness strategy if you work in a local authority, so these are organisations that are trusted to, or commissioned in some cases, to deliver essential services for people that are experiencing homelessness, so it completely makes sense to draw on their expertise to help inform your assessment, so you do not have to go at an assessment completely on your own. And, again, you know, this is just reinforcing the-, the aspect that it's not just about particular conditions related to health, but it could be related to circumstances that are sometimes described as social, but of course, you know, what you want to do to inform your assessment is draw on several different aspects of things that are available to you, potentially on your very doorstep. And, again, no one is expected to know it all, but you can act on what you are reasonably expected to know, so-, and one of those things include knowing the services that you have available to you locally and the expertise that is around.

One of the things we want to do, in terms of assessing anybody who's experiencing multiple exclusion homelessness and, again, here the guidance allows us to do this, is provide those questions in advance to the person, so that we're not cold calling them or making a phone call and perhaps, you know, they may then be really hesitant or reluctant or describe to you that everything is okay. So, providing things in advance about the questions that are going to be asked and in formulating those questions you would have, hopefully, used the expertise available to you, so you can work collaboratively right from the very beginning with partner agencies before the assessment even happens to help you formulate those questions. I think taking into account things like the accessibility, the format, the list of questions, you know, how much is it the person can realistically cover in one session? But also thinking about things like the timing, the format, is it a phone call, is it face to face where possible? Obviously things have changed in that respect, and it's absolutely fine that if you can't get contact with the person directly, that you do it through the organisations that are well placed, that potentially know them really, really well as part of your initial information and fact finding exercise. So we really do need to balance this, 'Do not engage' narrative that we often find in complex case work but also in safeguarding adult reviews, with a question that we need to critically ask ourselves about how do I, or how do we engage with the person? And here it is, some of the guidance that will allow you to think through these different things so that when you get to a point of an assessment, it's made more realistic and potentially possible to start to come to terms and understand what care and support looks like for the individual. So, and also, we want to think about things like the persons substantial difficulty being involved in an assessment process, and you know, and those difficulties can arise from things like cognitive impairments, or difficulties processing information, and we want to have a look at things like section 67, the independent advocacy rights that people have as well and to again build that in, hide it into as an organisation making a referral, but also as an assessor doing the initial screening and understanding of a particular situation, so that when you get to a point of an assessment, it's made more possible and more realistic for everyone.

What we've developed as part of where I work is a care act tool kit. This care act tool kit is available, you know, an internet search will bring this up, there's a link on the slides as well. And what this essentially does is, it's about defining those needs, those care and support needs in context. It's collaborative as well, so, and again, you know, you might want to use this, again, not as an assessor on your own having to do an assessment, but certainly good practice will be sharing that assessment out with the agencies that are involved in the case to then come up with that sort of engagement strategy to then involve the person, because if you're going to go about it by calling the person directly, it's very, very likely that one, they may not have a phone, two, they've lost their phone, they're no longer in a place where they were at when the initial referral went through, so you need to take all these things into account. These things are now well documented and well known, so we need not wait for people to get in touch with us and we can be very, very proactive about our assessment duties. And, the tool kit is also research based on Sky Literature as well. So, there is a link, have a look at it, and use it as a document as well as an aid memoir to yourself as well about how involvement could potentially occur. And assessments for someone, be it post assessment or during the assessment itself, it need not lead to expensive packages of care and support, and the care act does allow you to pause as assessment process and provide services through often early interventional targeted interventions, sometimes called enablement or re-reablement, to help you again objectively define what it is the person can or cannot do, and these are often short term interventions that can really, really work and prevent needs from worsening or from escalating.

What you don't want to do is sign post people away without finding if there are actual vacancies or those services are out there, or understanding how that person themselves has actually interacted with those services before their referral was made to adult social care, for example. There are some tips here, I'm not going to go through them each and every one, but it's pretty much a summary of what I've said, so I'm going to start looking at the protection planning aspects, and we know this is called the three part test, and we also know that some local authorities don't like calling it the three part test. So to kind of ground this discussion, I've borrowed from ADAS guidance and in that guidance it's called the three part test, so hence I'm putting it across to you as the three part test, and this is to do with the safeguarding criteria that would trigger or not a safeguarding enquiry. And we know some of the background, there was some statistics released just the other day showing that the mortality rates of homelessness, people that have died across England and Wales is up by 7.2%. That's not statistically significant, however it is the highest amount of deaths that we have seen since the stats have been collated back in 2013. The average age has also not changed much. So, it's just on the 46 for men and just over 43 for women. And what we know also is safeguarding adult reviews have been commissions, you know, as Michael was saying, there's 25. These safeguarding adult reviews are essentially, they're really, really powerful tools and really rich sources of learning material for anyone at all levels, and if you're a practitioner, do read these because usually you'll find material in there, whether you go straight to the recommendations, and from that you can extrapolate ways of, that may want to influence how you work in terms of your assessment but also in how you might want to work with other agencies as well.

So in terms of the safeguarding aspect, I was involved in a piece of research with Kings College London that analysed some of these safeguarding adult reviews. There was a series of fourteen different safeguarding adult reviews that we looked at, that involved sixteen different people and there were some themes that I was able to pull out of those. So, and again, I won't go into too much detail on each of these themes but what we- and again, but some of these themes that I'm going to present here were actually asked in the Q&A about who should lead. 'Should there be a support worker leading?', was one of the questions I got asked, and again this is often brought up in safeguarding adult reviews about who leads the multi-agency team? You know, and getting those very basic things right, and I do have a couple of slides after that, perhaps give you some practical tips of what that might look like. We know about the lack of professional curiosity and normalising the risk that peoples face. And then we also know about the assessment routes sometimes do not work, and what I've given you here is some suggestions and tips based on a statutory guidance that will allow you to try and at least attempt to have routes to an assessment that will involve the person, but also involved agencies that are working with the person. We know that the three part test is based on adults, whether they're physically present, that are physically present in the area, whether or not they're ordinary resident there, that they have care and support needs and that are at risk of experiencing abuse and neglect and are unable to protect themselves. But key to this is reasonable course to suspect, so this is not a yes or a no right from the very start. 

So, those who are making safeguarding referrals or those who are doing the initial triaging referrals, you know, need to remember that this is about reasonable course to suspect, and that runs throughout the three part test. So, and even if the duty is not triggered, it does not absolve practitioners of their duties. So in the event that there is no duty to make an enquiry, ADAS guidance reminds us that practitioners must still consider and record how any identified risks will be mitigated, and how that will be communicated to the adult connected, but also the partner agencies. We find this time and time again, safeguarding adult reviews, that feedback is not given to referring agencies and there seems to be a communication breakdown. Now, the guidance that's available absolutely gives you permission to, you know, communicate responses back to partner agencies, and as well as understanding when it is best place to look at risks from within the section 42 enquiry process or as an alternative risk management, and again, there are other processes like IMARA, for example, that might be best suited, so under section 42, it's not to replace any of those aspects or groups that may already exist. Some of the tensions that we're seeing, or certainly that, you know, safeguarding adult reviews are telling us, but also from our own experience is that we apply the three part test in a very narrow way, and we can often get lost in criteria. We start talking about the care and support needs, ability to self protect and lifestyle choice narratives, can often, very often get in the way of understanding the next steps of a particular case.

And also, and this is a thing for agencies that are referring in as well to local authorities, that sometimes information is relayed as a stream of consciousness, with the occasional full stop, although very, very useful, sometimes it can be quite easy to get lost in that detail, especially if referrals come in that kind of unstructured way, and sometimes all the information doesn't include the relevant facts. We often see, and again this is a pattern that's coming out in thematic reviews that have been done around homelessness, is we often forget to admit the, seeing the patterns for both the individual person, in terms of their interaction with agencies, but also how agencies are working together. So, if you're a social services body or a safeguarding team looking at a referral, you know, it's very, it's well worth understanding how many notifications or concerns, or PPN's, or whatever the term that might be used, all referrals have been submitted, it wouldn't be uncommon for different agencies to be raising concerns in different ways about the same person, sometimes on the same day as I've read in a safeguarding adult review recently. So that's a point of curiosity for you, that if you're responsible of looking at a safeguarding adult- a safeguarding referral, then you want to understand right from the very start how agencies are working together, and this needs to be explored, so we need not wait to understand how agencies are working together at a section 44 level which is looking at inter-agency collaboration, but you know, using that kind of, that initial stage to prevent cases from becoming section 44's by understanding how other agencies are working together.

It is a clear indication to you that multiple referrals, there's something going on, that is not always necessarily down to the individual person, but also about how agencies are working together, which sometimes means they may not be speaking or communicating their risks or shared risks, because it's usually they will have concerns about the same things. And getting the basics right before you do move into a multi-agency response, I would say, from my own practical experience, that it's very rare that case involving multiple exclusion homelessness doesn't need some sort of multi-agency meeting of some kind, whether that's section 42 or another different kind of risk management process. And these meetings setting clear agendas, securing the right people around the table, understanding where viewpoints are lines and where there are point of uncertainty, and you know, things like smart actions and monitor and review progress. So- and then asking questions as well, so using the information you have to set a series of questions for the multi-disciplinary team to explore, that's absolutely fine, so it's not always about securing services, but certainly about understanding needs and risks in context. Things like understanding the likelihood and severity and impact of a particular risk because at that understanding of risk and impact of risk may be different across agencies, some over estimating risk, others under estimating it. So, it's really good to bring these things onto the table to have some sort of consensus. And again, you know, using this process to work through the immediate risks of course, but as well, you know, you want to have something in parallel that looks at the medium to longer term.  

And again, you know, there are, and I guess that there are powers within the section 42 process in that, you know, you can, it absolutely enables local authorities to draw upon the cooperation duties, to illicit from other agencies reasons for refusing to do whatever is asked of them, and sometimes that refusal may not be a direct refusal, but maybe by not getting back to you, so there's absolute ways of bringing partner agencies together. Okay so, and again, because there seems to be a trend in my professional career with developing tool kits, here is another one for you. This is a recent one that was released a prototype, so it's not quite finished but there's enough there to get you started, and it's a tool kit for practitioners to look at multiple exclusion homelessness in particular. This is no- and it was a tool kit that was done in collaboration with academic researchers, lawyers and independent safeguarding consultants, as well as practitioners, and it has been subject to appear review at this initial stage, and we're hoping that come the summer we'll have released a final version. So, if you do get to use this tool kit, then please do get back to me with any feedback you might have, my contact details are going to be towards the end of the slides. And again, this is a way of fact finding, you know, and making sense of information against care and support needs, about risk, how to estimate and do those particular aspects of the work. And then, to make you, to give you an objective decision making tool that will allow you to essentially understand where your duties have- where they sit, where they lie, and ultimately this is about the fencible decision making. I think we're very much nearing the end, so I'm going to skip these bits, but this was about the structure of the tool kit itself, just to give you the next couple of minutes how it looks like.  

So, there's essentially three questions running through the tool kit. The first one is, 'Have you somewhere safe to stay tonight? And can you get the help you need there to meet your basic needs?' The second one, which is a really, really key question is, 'Do you understand why I'm concerned about the level of risk to your wellbeing?' This is starting to give you, as a practitioner, an insight as to how the person may conceptualise or actually understand their situation in context, and what sort of weight they give in terms of the information they have available to them. Bearing in mind also the things that Michael has explored around multiple complex trauma and people's understanding of risk, including an institutionalised understanding of risk, especially if their life course has meant that they've been involved with statutory services and non-statutory services for a very long time. And again, what help you need now to protect you, and how should partner agencies work together? This is a question for you as well in terms of when you're either submitting a referral or having received that referral, is asking yourself that question, how can we best work together? And the tool kit is then divided into four sections. You need not complete every single section, it's entirely up to you. Again, you can just use it as a reference, this is not here to replace your own local policies and procedures, but it is just an assistance for you to be able to work out and map out what's going on. And what you'll find on the margins on each page are links to relevant law, legal precedent, also safeguarding adult reviews, and other tool kits and resources that are available, and these are available as hyperlinks so if you were to use the form electronically you can click on that and it will take you to further information that gives you some of the rational behind different decisions and different processes.

Moderator: Bruno, I think we need to leave a bit of time for questions. Was there anything else you wanted to say? So, you're running through the tool kit sections, was there anything else you wanted to say before they move us on?

Bruno: No Adie, I think that comes to the end of it. But just to say that obviously, you know, the flyers will be available through the website. But I really do urge people to have a look at the tool kit and you know, use it as part of their ongoing development.

Moderator: Well, I think both of the tool kits that you've been involved in producing have been absolutely invaluable in terms of providing resources, really practical resources for people to be able to use day in, day out with prompts and, you know, with that level of applying, you know, legal literacy to practice which is so important, but also really practical stuff, and a lot of the things that you've talked about have been raised in the questions. I'm gonna ask you a couple of specific questions because I really want to give some space for people who've put them in the Q&A. So the first one, which is quite straightforward in some respect is, can a care act assessment for care needs only been actioned by a social worker? And I think I would add to that similarly a safeguarding enquiry. Do you want to just say that very quickly, what the response is to that?

Bruno: The decision making process sits with the local authority, but the process itself and how you get to the decision, I think there's flexibility with that. So, and I think when we approach these things is not confusing the two, you know.

Moderator: Absolutely, and I think your points about multi-agency involvement in that imparity of esteemed for colleagues, which brings me to the second question that was raised earlier, which is that someone may present different in an assessment process, say with a social worker than they might have done to other agencies involved in supporting them. And particularly for charitable sector, how do you get across that history of the persons experiences, rather than how they might appear or present on the day of assessment? And you've touched on that already, and I think it crosses over both the care and support needs aspect as well as the safeguarding risks area. So, do you want to say just a bit more, and Michael add into that if you would contribute too.

Bruno: Yes, I would say that the first thing that comes to mind Adie, is that the assessment is not a snapshot, so, and it needs to take into account things like fluctuating needs. So there will be good days and not so much good days, and the importance is, you know, not taking it always necessarily. Of course- you know, and making safeguarding personal tells us to take into account the persons wishes and what they tell us. But you know, having that health scepticism and curiosity as well so that we can objectively look at the persons situation. So taking into account their view, but also what practitioners that may not be social services led say as well and triaging that, and the care act tool kit is essentially designed with that in mind as well.

Moderator: Michael, did you want to add anything?

Michael: Well, just to reinforce what Bruno said I think and at the risk of using some jargon, triangulate the information. So triangulate what the individual says with what you know from elsewhere or what you might find out if you ask questions from other people who know the individual, and I think that highlights something I saw in the Q&A in the break, the importance of parity of voices here, and you know, there are too many examples in SARS of where practitioners, for example in third sector organisations had really important and useful information which either was not requested or not listened to when it was known, so it's about triangulating information.

Moderator: Absolutely. The second area I just wanted to reference is some other work that we've been doing through the CHIP programme, and Jane Lawson highlighted it in the Q&A, which is the-, I suppose, hopefully it's signposted through the toolkit around the safeguarding concerns framework, as well as the section 42 decision making. And not that everyone needs to be an expert, but it helps provide insight into what can and can't, as you've explained Bruno, be raised through the safeguarding processes. And I suppose, really, it's more a comment from me than a question, but you can come in if you like. That whole area of trying to prevent risk escalating, and the prevention aspect of safeguarding being sometimes downplayed against the escalating risk that people have to meet a threshold, I would love to ban that word, threshold for a section 42 enquiry. As if that's the objective, as opposed to the objective being, 'Let's try and help this person keep themselves safe and prevent needing that level of intervention and support.' So, I don't know if you want to say anything more about how we use these frameworks of assessment for needs assessment and for risk assessment and protection, to protect people and support them, as opposed to wait until things deteriorate to such a level that, you know, more serious risks occur to them in their lives.

Bruno: Yes. No. Absolutely. I think it just reminds me-, I think it's something Michael said, it might-, it might not have been in today's presentation, but at least before, about understanding, you know, what are the outcomes we want to achieve right from the very first start. And then looking at the different criteria and laws as a way-, as a conduit to getting there, as opposed to the other way around. And I think-, I think there is a confidence level aspect, in terms of raising multi-agency meetings, you know, and this could be irrespective of where you may be placed, in terms of your discipline or sector. So, you know, what is it, what are the barriers that are stopping people from emailing, or getting in touch with colleagues, to say, 'Let's have a multidisciplinary meeting to assess risk,' you know. And, and then through that process, then I'm, you know-, going through that process, we're setting actions and, you know, agreeing goals and targets. However, I think there's this myth, potentially, that the only way to raise a multi-agency response is through an existing framework like a safeguarding. So, I, I, I, I'd be keen to understand that a bit more, I suppose, and certainly, anecdotally, that's what I'm hearing. But, as we know, anecdote can soon become evidence through a safeguarding adult review.

Moderator: Unfortunately.

Michael: If I can just add, if I may, just to reinforce one or two things that, that Bruno has said. I think we all have a responsibility to make structured referrals. There, there was some useful guidance in at least one of the review published by Wiltshire Safeguarding Adult Board, that any referral should start with, 'This is what I am asking for.' And, and, and, and then having been really clear in one or two sentences, 'This is what the ask is,' then, then actually itemising why. And in relation to accessing section 42, the referral of concerns being really clear about the three part test and, and the information that you hold that meets one or more of the components of the three part test. And then, finally, the importance of escalating concerns where the initial feedback, if you get any feedback at all, is that, 'Oh, somebody doesn't meet the threshold for section 42.' Well, if you think they do, escalate your, your concern. And I have experience of doing reviews where, actually, the decision made by adult safeguarding has frankly been unlawful, totally outside of the three criteria that are in section 421. So, again, reinforce the reference to Jane Lawson's work on behalf of CHIP and LGA in, in relation to section 42 concerns.

Moderator: Yes. This makes me think we should add that into the resources. I'm going to move to another question, which is quite different, around the way in which needs assessments are very home-centric assessments, so the person needs to be living in a residence, i.e. not on the street or temporary accommodation, often to be seen to be assessed appropriately. So, there are lots of examples. So, the question is, how do we shift, I think, from that assumption of a home-first framework for assessment, in terms of helping, I suppose, social workers understand that moving from, say, the street to a home is part of-, potentially part of that work. So, I wonder if either of you have got any reflections on that.

Bruno: Yeah. And I, I think this reminds me of one of the recommendations made in the (mw 01.35.47) by Fiona, around using trusted assessors. So, organisations, you know, commissioned, often, by local authorities to deliver these sorts of services, you know, in, in that sense, trusted with, with cash to deliver. So, you know, it would make sense that the, the same people are potentially used to inform those assessments. And, you know, and it need not be a barrier. So, if somebody doesn't have a house, to-, that would allow an assessment to, to occur. This still doesn't absolve practitioners of their duties, you know, and, and you would want to take into account things like reasonable adjustments under the Equality Act, you know, and what sort of things can, can be flexed in order to allow that assessment to occur. So, the starting position is, is how to assess. So, the question, I guess, to, to critically reflect on from, from an assessor's point of view is, okay, we, we know the person doesn't have a home, so how can we make this assessment possible.

Moderator: Yeah.

Michael: And, and I would refer people to a reference that's in the briefing, published briefing, what we learned from Leicester City, where there is an outreach social worker. And the outreach social worker assesses where people are, and if they happen to be in, in, in a shop doorway, that's where the assessment takes place. And, if necessary, rather than simply signposting people away, to pick up a phrase that Bruno used earlier, the outreach social worker helps a person to go to where the person might actually be able to access both a roof over their heads and, and, and other provision. And I, I think the other thing I'd want to emphasise again, and it's about the point of escalation, I think that we should all model an aspect of John McEnroe's behaviour when he was a, a first rate tennis player, perhaps he still is a first rate tennis player, and he sometimes challenged decision making with a well-know phrase, 'You cannot be serious.' And, and I think all of us should, at times, be saying to decision makers, 'You cannot be serious. And the reason why you should reflect on the decision you have made is because.' And that's where Bruno's reference to the statutory guidance is, is, again, so helpful, because that's part of the authority that you have to challenge decision making.

Moderator: Absolutely. Thank you for that. And I'm whizzing through this because we, we're running out of time. There is a question around whether it would be helpful to have a risk scale template for risk levels, a bit like the hoarding scale, and what do you think of that. My personal view is, risk is so complex and multiple. I worry hugely about things being reduced into tick boxes, but that's my personal response of it, in terms of a-, of a personalised approach to individuals' own lives and their, and their situations. But I think that those types of scales and tools can be really helpful for people to frame and understand what's going on. And, certainly, the hoarding scale, in terms of moving us away from judgements that maybe very personal to an objective, hoarding scale of pictures that show levels of hoarding has been really, really helpful in that area of safeguarding practice, to move away from a, a, sort of, subjective judgement around other people's risks. So, I, I think it's a really interesting question to pose.

Bruno: It, it certainly is and I, I think, yeah, I think risk scales can certainly be useful. If they're done in isolation, as in just the particular service, then there is an added risk that the way that risk gets measured or looked at, especially the severity and impact of the risk, is seen differently across disciplines. So, you would have, practically speaking-, it's about, you know, understanding of what is safe and what isn't, you know, So, for one area who may be-, one particular organisation that may be less experienced in multiple exclusion homelessness, they may underestimate risk and the severity of risk. And those that are well-versed in homelessness may actually overestimate the risk as well. So I-, and I think a way of reaching consensus is to bring that, kind of, risk assessment template that you want to use as a multi-agency team, and then put that on the agenda of the meeting, about reaching consensus in terms of severity and impact of risk, certainly, and identifying the risk as well in the first place would be a good way. And I, I've used that and it seems to work.

Moderator: Thank you.

Michael: And, and, and I, again, I would add, and Walter Lloyd Smith is the business manager of the Norfolk SAB, did some work that-, where he lifted the triangle of assessment of children in need and their families, that framework, and applied it to self-neglect. That would be one template that could be used. There are other risk assessment templates that ask us to focus on the likelihood of particular risks arising and the significance of them if, if, if they did arise. I think what we have to remember is, the risk templates are just that. You know, they are templates. So, we have to adapt them according to the uniqueness of each situation that we encounter, rather than follow them slavishly.

Moderator: Thank you. I'm going to ask-, Bruno, can you take down your slides, and Michael, could you just put up the last ones for the final couple of minutes? So we were just-, apologies to anyone who has raised a question that I haven't been able to answer. I'm afraid we haven't been able to cover everything this morning, but we will take a record of the chat and the Q&A, and make sure that those issues are picked up in, in further sessions and briefings. I just wanted to briefly go through, Michael, if you just go to the slides, some of the things that we're planning. So, as we said at the beginning, this is a number-, the first of a series of workshops, and you've got on this slide, and the next slide, the dates and the focus for the next workshops. Please, to register, ignore the CHIP reference on here, go to the LGA website, much quicker, hopefully as you did today, just log through the LGA website to book yourself on to any of the other sessions that we're holding through to March next year. Moving on to the next slide, just to remind people, as Michael referred to analysis of Safeguarding Adult Reviews, there will be a recording made available and the reports are now available. There's some-, there are two sessions around making personal-, making safeguarding personal resources being organised for next year as well. So, there's a number of elements in the-, in the work programme. There's a further slide, I think, Michael. To-, we're continuing to capture information on safeguarding adult data through Covid. We produced a first report that looked at information up till March. We're hoping to do a second report that captures information up to the end of this month. And as I referred to earlier, building on the work that Jane Lawson did around section 42 enquiries, there's a whole series of workshops looking at safeguarding concerns and that-, the issues that Bruno very articulately refers to around how to raise concerns and how they've responded to. Hopefully these workshops provide some mechanisms for people to be able to get, I suppose, more confident in how to manage the processes that we're all involved in, in terms of trying to protect people. So just, finally, to say thank you to everybody for joining us this morning. Huge thanks to Michael and Bruno for the presentations, thanks to Nikki, and Tara, and Anusri, who, behind the scenes, and Mike, have been making this possible. This has been the first time that we've done an event like this and there's been over 200 people participating. It's a fantastic turnout. Hopefully really helpful to colleagues, in terms of contributions and hearing from our two colleagues. It's now 12 o'clock, so I think we're going to be cut off as time is out. Thank you everyone for joining us this morning. Thank you. No, we can't-, we can applaud ourselves, but it's a bit silent. So, thanks everyone.

Presentations

Safeguarding Adults offers
Dr Adi Cooper OBE, Care and Health Improvement Advisor, Local Government Association

Adult Safeguarding and Homelessness: foundations for positive practice
Professor Michael Preston-Shoot, Emeritus Professor of Social Work, University of Bedfordshire and Chair of the London Region Network of Safeguarding Adults Board Independent Chairs

Understanding care assessments and safeguarding planning for people experiencing homelessness
Bruno Ornelas, Head of Service and Safeguarding, Voices of Stoke and Brighter Futures