This briefing paper was developed in response to sector concerns regarding the impact of the cost of living, hospital discharge and winter pressures on safeguarding adults’ activity. It constitutes a national ‘temperature check’ for the period between April 2022 and March 2023.
Rationale and methodology
This is the executive summary of the report. The full report is also available to read.
This briefing was developed in response to sector concerns regarding the impact of the cost-of-living, hospital discharge and winter pressures on safeguarding adults’ activity. It constitutes a national ‘temperature check’ for the period between April 2022 and March 2023.
A wide range of stakeholders, including the National Safeguarding Adults Board (SAB) Chairs and SAB Manager Networks, the safeguarding adults policy leads from the Department of Health and Social Care, Adult Principal Social Workers Network, and Association of Directors of Adult Social Services (ADASS) agreed that there was a need to better understand this impact and share information about the constructive interventions and innovations developed in response to changing safeguarding needs.
Partners in Care and Health safeguarding leads developed an online survey, which obtained 42 responses from councils, safeguarding teams and SABs (representing 27 per cent of top tier and unitary councils in England). This requested qualitative intelligence on safeguarding activity, local good practice to mitigate risks of abuse or neglect, insights to help inform prevention and protection work and future planning in the context of the cost-of-living, hospital discharge and winter pressures. The councils participating in this project are a small and self-selected group; they provided a snapshot of activity between April 2022 to March 2023.
This briefing is based on the perspectives of individual councils who shared both their concerns but also examples of strategies of how they were addressing the impact cost-of-living, winter pressures and hospital discharge. As quantitative data is not corelated by councils on specific areas of cost of living, winter pressures and hospital discharge with returns to the NHS Digital Safeguarding Adult Collections (for example) it was difficult to ascertain statistical measurable changes.
This is the executive summary of the report. The full report is also available to read.
Key findings
Multifactorial interconnectivities – whole system responses
The overarching key finding from the responses was that the cost-of-living, winter pressures and hospital discharge impact through multiple factors that interconnect, not only in relation to each other, but also other factors, such as the long-term impact of COVID and ongoing inflation. This manifests in casework as increased complexity of safeguarding risks and situations.
Recognition of these multifactorial interconnectivities was reflected in many of the interventions which required multi-agency and partnership working both strategically and operationally across the system.
Strategic collaborations were developed to creating shared frameworks, structures to allocate resources, across various strategic boards and sometimes involving people with lived experience.
Strategic buy-in was a lever to enable change. Co-located, multi-agency initiatives, which took a system and contextual approach to responding to adults’ care and support as well as safeguarding needs, were helpful. Respondents described exploring synergies between partners within the system on specific areas, developing a more systematised set of relationships which manifested in structures such as multi-agency services or hubs.
Alternatively, physical presence in other parts of the system beyond health and social care spaces grew trust in the system (especially in a post-pandemic world). Additionally, successful projects took preventative and holistic approaches to adult safeguarding where they considered broader safeguarding and care and support responsibilities.
The innovations demonstrated how multi-agency approaches provided a powerful preventative tool, through strong partnerships across statutory services (including police, health and social care and blue light services), with providers in the private, independent, community and voluntary sectors.
Addressing poverty
A common response was the development of initiatives and approaches focused on addressing poverty, through creating spaces, forums, summits to discuss local issues and working with the voluntary sector and multi-agency hubs to find collective responses, practical actions, co-ordinate resources and make collective plans. Whilst these initiatives were helpful, there were concerns that some people were falling between services, or 'hidden' from sight, in terms of their adult social care or safeguarding needs.
Examples of prevention work with people were cited, for example using a strengths-based and/or trauma informed care approach or using social prescribing to connect residents to community groups, activities and to prevent loneliness and isolation and prevent people developing more complex and/or higher care and support needs. The ending of the Household Support Fund was a significant concern for councils and their partners who recognised that this would exacerbate poverty and related safeguarding concerns.
Mental ill-health
Council respondents reported impact of higher levels of mental health referrals; mental health issues were threaded through the responses, as a factor in complex presentations of safeguarding concerns or people experiencing risks presenting to adult social care or partner organisations.
Partner agencies such as supported housing services were reporting higher mental health needs and risks. Councils provided examples of targeted initiatives to address the needs of specific groups of people, such as those who experience homelessness or socio-economic disadvantage, or to address specific issues such as mental health problems or self-neglect.
Cost-of-living impact
Councils found that the increases in the cost of living had diverse impact on residents. They reported that increasingly, people with care and support needs were unable to afford their paid care workers and rejecting necessary care. Some councils reported: increased severity of risk; increased levels of domestic abuse and reduced ability of the victims to leave; increased levels of safeguarding concerns of self-neglect; some 'hidden' residents neglected in the community; increased reporting of neglect and acts of omission from care and health providers; increases in paid care workers financially abusing their clients (theft) because of their own financial struggles.
Adult social care and safeguarding referral was also being used for people who were struggling with the cost-of-living impact who did not meet eligibility criteria. The provision of subsistence payments was available to offset some cost-of-living risks and this was valued by respondents, particularly for those struggling to access services or were experiencing multiple disadvantages.
Winter pressures and hospital discharge
It was significant that councils did not have specific data regarding winter pressures, hospital discharge and safeguarding, however they were able to provide some insights and observations. The demand for health and care services, (including mental health), community and voluntary sector and ambulance service tends to increase significantly with the onset of cold weather, flu, COVID and so on(from the end of November/December to March). Although council respondents described how safeguarding referrals felt indistinguishable during winter pressures and other times of the year.
There is also some discrepancies as to start of winter which can be from November or December dependent on organisational/sectoral pressures see: NHS England, NHS Education England or NHS Providers.
‘Hospital discharge’ is the process when a person leaves hospital. It includes identifying any safeguarding concerns and ensuring that the discharge is safe. Council respondents reported that there were higher levels of acuity and complexity in hospital discharge over the winter period, with several issues concerning unsafe discharge such as care packages not being restarted or not put in place when the patient returned home; people discharged overnight without support; or people with increased complexity being discharged into care homes leading to high risk of safeguarding incidents.
Some councils reported that winter pressures combined with hospital discharge challenges saw an increase of people not receiving the correct care within residential or nursing homes and an increase in the number of out of borough placements. Others reported that a lack of available or suitable accommodation and support provision resulted in use of unsuitable emergency accommodation.
Workforce recruitment and retention
Council respondents reported recruitment, retention and workforce challenges, describing how cost-of-living pressures had an ongoing impact as people seek sustainable salaries and affordable housing. See also Skills for Care’s report, ‘The state of the adult social care sector and workforce in England (2023).’
This was exacerbated by industrial action, which added to the pressures across the system in winter period. Reliance on agency workers across health and social care was reported as having a significant impact on service delivery. Provider failures were also seen as related to the cost-of-living impact.
Conclusion
A pro-active and multi-agency approach, focused on early intervention, responding to the adult safeguarding needs of residents which have been exacerbated by the impact of cost-of-living, hospital discharge and winter pressures was critical to success.
Preventative work was recognised as a means to address the impact of system pressures, but more challenging to fund. Council respondents described imaginative approaches to support people in their communities despite the huge challenges.
For further information please contact the report writer, Dr Anusree Biswas Sasidharan at [email protected].