Voices from the frontline: social work practitioners ...

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Voices from the frontline: social work practitioners’ perceptions of multi-agency working in adult protection in England and Wales

Centre for Health and Social Care, University of Leeds

abstract

Bridget Penhale

This article reports on the views of 92 social workers about their practice in adult protection in England and Wales as part of a wider study of adult protection working and regulation that took place between 2004–2007 in 26 sample local authorities. The article explores social workers’ reported experiences of partnership or multiagency working and how this, along with overarching regulatory frameworks, affected their practice within and across agencies. Among findings from the study were that social workers considered that sharing information and responsibilities led to positive outcomes for service users and that the incorporation of different agency perspectives supplemented sharing of best practice.

key words adult protection, multi-agency work, social work, partnership, regulation

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Lisa Pinkney

Centre for Health and Social Care Studies and Service Development, University of Sheffield

Jill Manthorpe Social Care Workforce Research Unit, King’s College London

Neil Perkins Centre for Public Policy and Health, University of Durham

David Reid Centre for Health and Social Care Studies and Service Development, University of Sheffield

Shereen Hussein Social Care Workforce Research Unit, King’s College London

Background The discussion that commenced in the United Kingdom around the New Labour government’s emphasis on ‘partnerships’ as an essential theme of its ‘third way’ occupies a prominent place in health and social care literature (see Lymbery, 2006; Clarke & Glendinning, 2002; Glasby & Dickinson, 2008). Partnership working has become a central feature of all public services (Balloch & Taylor, 2001), and is also a major element of the modernisation agenda (see DoH, 2007). Although partnership or multi-agency working (often described as inter-agency working, co-ordination or collaboration) can be seen as a rational response to divisions

© Pavilion Journals (Brighton) Limited

The Journal of Adult Protection Volume 10 Issue 4 • November 2008

Voices from the frontline

within and between professions, and between government departments and local authorities, challenges remain in ‘operationalising’ this ideal within health and social care. Ling observed (2000 p82) that ‘partnership’ is ‘a word in search of ways of giving it meaning in practice’. A troublesome issue remains in defining what is meant by the term ‘partnership’, which has a bearing on both the development of services and their evaluation (Glendinning, 2002; Dickinson, 2008). Although closer collaboration (one way of operationalising partnership) is seen as a ‘good thing’ (Hudson & Hardy, 2002), and there may be room for cautious optimism in collaborative working in older people’s services (Lymbery, 2003), long standing challenges remain, such as power and culture clashes (Hudson & Lewis, 1999; Hudson, 2002; Lewis, 2001). Also, much research into health and social care partnerships has focused on process issues with less attention to outcomes in both an end-user and organisational sense (Dowling et al, 2004; Dickinson, 2008). A government focus on means and structural issues could explain why much research has focused on these aspects (Dickinson, 2006), but the focus on processes is possibly due to the definitional and professional issues that confound partnership working, and cause delays at both definitional and structural levels, leaving less room for exploring individual outcomes at operational levels. The government concern with partnership working in a wider sense has been reflected in both policy and legislation in recent years. This has been evident in such documents as the NHS Plan (DoH, 2000a), Independence, Well-being and Choice (DoH, 2005), Our Health, Our Care, Our Say (DoH, 2006) and legislation such as the NHS Act (1977) and the National Health Service Act (2006) that require health and social care organisations to work together and to collaborate. These requirements do not specifically state that it

extends to work within adult protection, although there are implications that it applies across the range of the adult health and social care interface. The Department of Health’s (DoH, 2000b) guidance No Secrets (and, in Wales, In Safe Hands; National Assembly for Wales, 2000) were composed within this government climate and encouraged partnership working within adult protection (now more frequently termed ‘safeguarding adults’; see ADSS, 2005). However, despite this exhortation within the guidance, no specific or statutory requirement was made on the different agencies involved in adult protection to work together. It is the implementation of these guidance documents at practice level and social workers’ perceptions about partnership working and the role of regulation that are the focus of this article. Additionally, No Secrets (DoH, 2000b) gave local authorities the lead agency role in co-ordinating adult protection activity. It forms the basis of their activity at the level of policy and procedural responsibility. However, the work, responsibilities and roles of social workers were not explicitly defined within the guidance. It is therefore this element of the implementation process that we discuss here. The study reported in this article built, in part, on earlier research examining the implementation of No Secrets (see Mathew et al, 2002; Sumner, 2002). It formed part of a larger study funded by the DoH within its Modernising Adult Social Care (MASC) research programme (2003–2007), (see DoH, 2007). The main study considered issues in relation to themes of partnership working and regulatory frameworks as they affect all stakeholders within adult protection, including senior managers, service users, carers and representative organisations (Penhale et al, 2007). The perceptions of frontline practitioners (social workers and/or care managers) were included as a key stakeholder group and it is



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these views that are reported and discussed in this paper. As the study was funded within an adult social care research framework, the major emphasis of the research was to obtain the perspectives of adult social care staff from within adult social services (although during the time that the study was undertaken, separate departments of adult social services did not exist throughout local authority social services departments). The views of representatives of organisations attending adult protection committees, comprising broader multi-agency perspectives on partnership working are reported elsewhere (Reid et al, 2008).

Methods The main study incorporated a quantitative phase, a survey of local authorities, and a qualitative phase, which consisted of focus groups of multi-agency adult protection committees and semi-structured interviews with a range of stakeholders. The final phase of the study examined the perceptions of service users, their carers and supporters about adult protection in a more general sense. This paper focuses on findings from the second, qualitative phase of the research and draws on the views of social workers working at operational levels, within local authorities. The main job titles of participants were social worker, senior social worker, care manager, team leader and senior practitioner. Respondents were purposively selected to cover a range of practice teams working with adults (older adults, learning disabilities, mental health, physical disabilities, including sensory impairments and hospital-based social workers). In the second phase of the study, to which this article refers, a purposive sample of 26 local authorities was selected across England and Wales, based on a framework seeking

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variation of type and geography, and contact was made to discuss the study. All but three agreed to participate, and these three were replaced by similar authorities from a reserve list. Research governance approvals were secured as necessary. This article focuses on the qualitative data derived from semi-structured interviews held with adult social care practitioners. Overall, a range of staff working in these 26 local authority social services departments in 2005–2006 participated in the study. This included adult protection co-ordinators, senior managers, middle managers and those involved in training and policy issues, as appropriate, as well as frontline practitioners. A minimum of eight interviews were held in each authority; adding up to 260 interviews in total. In each area, at least four interviews were held with frontline practitioners, in order to cover the range of practice teams within adult social care. Topic guides were developed for the semistructured interviews building on baseline literature and discussed within the research team and the project advisory group. With consent, interviews were recorded and assurances of anonymity given to participants and for their employing authorities. Qualitative analysis of interview transcripts was undertaken using a framework analysis approach in order to provide a systematic, disciplined and visible framework (Ritchie & Spencer, 1994 p177) and to support the analysis of a large amount of qualitative data within a limited timescale within an applied policy research context. The research team used the NVivo 2 software package specific to the analysis of qualitative data (Basit, 2003). The use of such packages helps analysis to be systematic, reliable and transparent, which in turn can strengthen the conclusions drawn (Pope et al, 2000). Relevant issues and themes were derived from the analysis and discussed within the research team and the study’s advisory group.



Results Strengths of multi-agency working at operational level Most social workers considered that one of the main strengths of multi-agency working within adult protection work was being able to share information with other professionals, often at a person to person level, and particularly between social services and the police. As one respondent stated, ‘… people are very willing to share, obviously when there are issues of safeguarding and protecting people … they are always willing to share that certain experience here’ (senior practitioner, area U). Shared decision-making and shared responsibility for service user outcomes were also seen as positive aspects of multi-agency working and participants talked about a gradual move among local agencies towards equally shared responsibility for their role in the adult protection process. Social services were seen initially to have taken sole responsibility for decisions in adult protection, with the implementation of No Secrets (DoH, 2000) and In Safe Hands (National Assembly for Wales, 2000) but many commented that increasingly, decision-making was being shared between agencies as joint policies and procedures were revised and developed, as illustrated by this respondent: ‘ …My perception is that it’s shifting. I think it’s coming from a position where social services were doing almost everything, if not everything, and … what’s coming in is the revised procedures which have got explicit demarcation of levels of response and different routes and organisations…’ Q: ‘So at times other agencies will take the lead role?’ ‘Yes they will, we delegate the process to them, and keep the overview…’ (senior social worker, area M).

Sharing responsibility was seen to result in a more co-ordinated response to service users and consequently, a lack of duplication in the adult protection process. Different agency perspectives were seen as being a valuable element of multi-agency working, and social workers felt that they were fulfilling their roles within adult protection more effectively by pooling different opinions and knowledge. New skills learned from other professionals and the sharing of best practice were also much valued. Additionally, the role of adult protection co-ordinator (where there was a co-ordinator in post), was seen as very helpful to frontline practitioners. Nonetheless, most social workers considered that multi-agency working was still at a relatively early stage, particularly in relation to links with smaller voluntary agencies.

Barriers to multi-agency working Although sharing information was seen to be a strength of multi-agency working in adult protection, information sharing could be problematic. Data protection rights and confusion about what information could legally be shared between agencies, were mentioned frequently by participants, with other professionals being described as ‘having a lack of confidence in sharing information’ (social worker, area D). This was said to be a problem, especially for hospital social workers when working with health professionals within hospital settings. In some areas initial enthusiasm for partnership working had been evident, but this was followed by an apparent lack of involvement including difficulties in obtaining information and having to ‘chase up’ colleagues. Social workers recognised that different agencies could have different responsibilities, for example, that police officers may dedicate more time and resources to cases that might result in a criminal conviction, resulting in less



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time for other cases of possible abuse. Such discrepancies made the adult protection process seem ‘a bit fraught, because other agencies don’t always see it as their priority’ (team leader, care management, area C). Similarly, social workers cited competing priorities within the National Health Service (NHS) when dealing with suspected cases of abuse. There was a feeling among many respondents that other agencies were relying too heavily on social services to accept the prime or even sole responsibility for adult protection. Differing professional and organisational perspectives were consistently seen as dividing health and social care, and the ‘social versus medical model’ was cited many times by social workers as a barrier to multi-agency working. Social workers spoke of different ‘cultures’ and ways of working with people, which often caused problems in their practice in adult protection work. One respondent stated, ‘… health … they just look at the issue of the health need, treat that, and then it is over to social services, whereas they [health care professionals] have a duty of care and you have to explain the procedures to them’ (team leader, hospital care management team, area C). A number of social workers spoke of a lack of knowledge among their NHS colleagues about adult protection. They ascribed this to a lack of training ‘… the care trust and the hospitals themselves, the acute hospitals, don’t have a good understanding of the No Secrets policy or the procedures and guidelines within that … there needs to be more awareness within health and joint training’ (hospital social worker, area C). Many social workers also cited an apparent lack of commitment from other agencies as an important barrier to partnership working. Several described difficulties ‘getting’ police to attend meetings. This was perceived as arising from a lack of knowledge, rather than lack of interest in the topic. Quite a few social workers singled out general practitioners

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(GPs) in particular for showing a lack of commitment to adult protection work. As one respondent stated, ‘GPs don’t want to be involved’ (senior social worker, UA5). Additionally, a number of social workers highlighted limited knowledge-sharing within their own departments and felt that ‘information frequently does not cascade down to operational level’ (social worker, area V). Frontline workers could feel they were the ‘last to know’ (social worker, area D) about information on procedures within adult protection.

Resource issues Many of the social workers argued that a lack of resources, in terms of financial, human and time constraints impacted on the extent to which agencies worked together and their own capacity for involvement activities. One outlined the result of this: ‘… too much work and not enough social workers or unit managers, or whatever, to do it… So you spread yourself thinly and you are not giving each case the amount of attention that it needs’ (social worker, adult disabilities, area V). Time constraints were often cited as a reason why adult protection meetings were difficult to co-ordinate. Although resources were generally viewed as inadequate, social workers considered that multi-agency working rested on individual professional commitment: ‘It’s goodwill and it’s networking because it hasn’t really been formalised’ (senior practitioner, mental health, area N). Goodwill was a particularly significant factor, according to many respondents, when ‘dealing with’ the police.

Training Adult protection training had been undertaken by most of the social workers interviewed but there were a variety of views about its adequacy. Most training was offered at basic level, covering awareness of adult



protection issues, and many felt that this was not specialised enough for them: ‘ … adult protection (level) 2 training I have done; I found that quite basic and frustrating. I didn’t really feel it was enough and when the adult protection (level) 3 training was coming along everyone on the team wanted to go for it, but we were told that really it was for unit managers and senior practitioners … the (awareness) training is only a one-day training; it is totally inadequate really … one or two days training, it is not enough.’ (social worker, adult physical disabilities, area V) Although training was, at times, frustrating for social workers, particularly if there was little opportunity for any ‘refresher’ courses to keep up with developments, practitioners attached importance to it. Most drew attention to the benefits of undertaking training with staff from other agencies. They considered that this equipped them to gain perspectives from other agencies and helped professionals pick up skills from each other, for example, that social workers could learn about interviewing skills from the police. In addition, participants considered that joint training fostered stronger relationships with other agencies, so that when cases arose they knew who to contact. When asked whether there were any drawbacks to multi-agency training, the general response from the majority was that there were only positives.

The impact of regulation and policy in adult protection Views about how far regulation and policy had impacted on the work of frontline workers, and which aspects they felt were most important were sought from participants. Typically, the majority of respondents spoke about No Secrets (DoH,

2000b) and In Safe Hands (National Assembly for Wales, 2000) as having the most impact, and considered that these were clear, with an element of flexibility. The main positive feature was felt to be simply the ‘existence’ of the guidance for raising awareness about adult protection issues. There was now transparency about local policies or procedures (or guidelines), which respondents thought gave them confidence in dealing with adult protection cases, in contrast to what had occurred ‘pre-No Secrets’. However, there was also a commonly held belief that what the guidance gained in clarity, it lost in ‘strength’. A key concern for some was that the document was Section 7 guidance, and thus did not have the full power of legislation. Some social workers felt frustrated with the guidance status, as illustrated by the following comments: ‘… it needs to have a back bone’ (social worker, mental health, area B), and ‘I think we feel quite frustrated that there is little we can do to resolve adult protection situations for the lack of legal clout and if things are pushed up the agenda to become more statutory I think it may go some way to resolving that’ (social worker, area M). Operational staff also considered that specific legislation covering adult protection would force other agencies to take it more seriously. One respondent thought that the guidance was still being ‘ignored’ and that ‘… legislation wouldn’t affect the people that already do it … the people that are taking notice of the guidance wouldn’t mind it being legislation, it is the people that aren’t taking note of the guidance that would probably object … if they brought it in as legislation it would make the people that are ignoring the guidance do something’ (care manager, area F). Others, however, raised the issue of human rights as a complicating factor in the debate about whether the guidance should be legislation. A minority of respondents decided that a ‘middle ground’, where the



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guidance should be strengthened, would be more appropriate and congruent with human rights legislation, and yet still allow for more flexibility. In contrast, there was less in the way of support for keeping guidance status. The sole supporting factor cited here was in relation to supporting people’s ability to decide for themselves whether to take action or not. However, a number of social workers said they were frustrated by the way in which human rights and issues over decision making when capacity was impaired (the study was undertaken prior to implementation of the Mental Capacity Act (2005)) seemed to obstruct professional powers to intervene in people’s lives when they did not want them to. As an example, one respondent highlighted a case that she had worked on, which she had evidently found very frustrating: ‘ ... If there’s a child at risk you can actually get to court and get an emergency protection order; when there’s an adult at risk I can’t go to court and get an emergency protection order, and you’re left sometimes actually sort of ‘balancing’ that risk and vulnerability within the community without being able to take any action. And some people would argue ‘well an adult is not a child’, but I think sometimes we need a quicker way in, when we have concerns about a vulnerable adult, and when there are adult protection issues. I think the only way to do that is through legislation.’ (team leader, area Y) Many social workers recounted occasions when they believed that people had experienced some form of abuse and yet, for reasons such as not having sufficient ability to be a witness, cases could not be taken further in terms of criminal prosecution. Respondents were hoping that the Mental Capacity Act (2005) (implemented in 2007) would have a positive effect. This applied in

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particular to cases where social workers had found it difficult to persuade people to agree to proceed with cases. ‘ … Some of the women that we work with, with learning disabilities, are in very abusive physical relationships with their partners, but make clear decisions that they want to stay within those environments … but, we can’t be sure that the learning disability doesn’t cloud some people’s judgement too. It is difficult. I hope it [Mental Capacity Act (2005)] will bring about an option to have people who lack capacity being supported to achieve the right outcome.’ (social worker, area U). There were several other cases cited where respondents considered that when working with adults, it was difficult to know when to intervene or to take control. Comparisons with child protection situations were frequently made, as most social workers thought that the legislation and procedures underpinning child protection were much ‘clearer’ with ‘far more to protect them [children] in law’ (care manager, area U). Although many social workers were quick to point out the pitfalls in the history of child protection regarding the ‘rigidity’ of earlier approaches to this area of practice, others felt that the regular updating that occurred in relation to child protection procedures was not occurring in adult protection. Some thought that the process of adult protection was, ‘all done a bit remotely [and is] … sometimes very ineffectual’ (social worker, area M). In some circumstances, legislation or the lack of it was said to be failing vulnerable adults. According to some social workers, procedures were in place, but the criminal justice framework was inadequate. There were accounts of difficulties in bringing cases to court. One participant stated, ‘… I think it’s something like one per cent that actually go to court … if there were ways that the evidence



that was given could have more weight really. I think especially for people that are in the community it’s almost like, you give licence for them to be abused’ (care manager, area I). One account given by a senior practitioner about a service user and carer with whom she was involved illustrated the complexity of practice in this area: ‘I don’t know how much legislation there is to back us up because we do contact (legal services of the local authority), I mean I have had one case just recently, … the man died in hospital of starvation and the woman [his partner and sole carer] is still on the street … my argument was when this man died where is the law now, [and] why can’t we help this woman who has done this to him? Maybe she needs medication, why can’t we have [she was a client of the social services department as well] her social worker try … to section her (that is detain her in a mental health unit for assessment or treatment) for her own benefit and for her health …where was the law?’ (senior practitioner, older people, area Y). Adult protection measures were often described by informants as beginning well, but with varying outcomes. One of these outcomes could be for ‘perpetrators’ of abuse to be placed on the Protection of Vulnerable Adults (POVA) list, which was introduced during the course of the study. However, views concerning this list were varied. Many spoke of the POVA list as a being ‘a good policy to bring in’ (care manager, area I). In the main, respondents reported that although it was a very positive development and, ‘a good idea in practice, it’s the implementation of it that’s just fraught and complicated’ (senior social worker, area M); this was in the early months following implementation, when our fieldwork began. There was also at times some confusion about whether people actually were placed or eligible to be placed on the POVA list or not (and

possibly lack of knowledge that referral to the POVA list is always kept on record), as one respondent stated: ‘I have been involved in perhaps half a dozen adult protection cases since the POVA list was introduced and I have never known anybody to go on it as a result of that even though there have been abuse investigations and … documented evidence there.’ (senior social worker, area J) In the case of Criminal Records Bureau (CRB) checks being undertaken on care workers and other staff, students and volunteers, overall these were viewed positively, with practitioners stating that they were, in their opinions, ‘essential’ (social worker, older adults, area D).

Improving adult protection Social workers were asked how they thought that adult protection might be improved. Most raised the issue of involving service users more in the adult protection process and hoped that they would play a more active, empowered role in the future. For example, awareness-raising about adult protection policies and procedures was mentioned as a valuable starting point, using some form of accessible information exchange, so that service users could more easily understand what was happening, ensuring they are ‘aware of what the next process is and who should be involved, and what information should be shared’ (social worker, area K). In addition, raising the profile of adult protection at a national level was seen as crucial. Many respondents thought that there was little public awareness, ‘… I think it would be beneficial to raise the profile of adult protection, and I think if we don’t resource it properly we are not going to raise the profile of



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it, and it is always going to be seen as the poor relation to child protection … we need some very clear guidance to do that...’ (team leader, area I). Lack of resources was linked, according to many respondents, with the need to raise the profile of adult protection. Many social workers requested more resources, both locally and nationally, and this centred on freeing up their time to do more work on cases, rather than staff being ‘overworked’ (social worker, area F). Many (equally unsurprisingly) requested more training, particularly multiagency training in adult protection, which also related to resource issues. In addition, a number of social workers thought that a specialist adult protection team might improve adult protection. Such a team would have to link closely with other core teams in order to work effectively, and not be remote or isolated. There was also a belief among some social workers that more joint ownership (of policies, procedures and processes) by agencies involved would improve adult protection in general, particularly in relation to the NHS.

Discussion This study was limited in that the views of the social workers were not considered in relation to observation of their practice and so their opinions cannot be verified. The views of other professionals could have provided useful and alternative insights into the perspectives held by the social workers. In the analysis we sought to counter this bias by applying some criteria of authenticity to the data (Guba & Lincoln, 1989), including fairness (the inclusion of all views), ontological authenticity (evidence of evolving complexity in our understanding of these issues) and educative authenticity (evidence of learning in the research team). In addition, the experiences and views reported in this

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paper are from a single agency perspective, which of course, makes it impossible to reflect a holistic view of multi-agency working. However, we believe that the issues raised in the paper provide a valid snapshot of social work practitioners’ views about this type of work, will resonate with other practitioners working in this arena and are likely to be reflected more broadly across the frontline where multiple perspectives are involved. In the discussion of the findings we focus on four key issues that arose from the data: information exchange, responsibility and accountability, resources, and legislation. While we consider each of these separately, they are interconnected.

Information exchange Information sharing was seen as a crucial part of adult protection practice. Social workers characterised good information exchange as both leading to, and the result of, closer relationships between agencies. If other professionals withheld information, mistrust often developed, which was not conducive to successful multi-agency working. Issues of sharing information appeared to centre around legal requirements in the NHS about patient confidentiality and data protection resting on general human rights concerns (see DoH, 2003). Social workers thought that these concerns and legalities could be better addressed through the development of interagency protocols on information sharing that would somehow circumvent legal safeguards.

Responsibility for adult protection The question of which agency should take main responsibility for adult protection emerged from the data as problematic. The social workers depicted a gradual spreading and sharing of responsibilities as agencies



became more aware of their roles and responsibilities within adult protection. In their view this appeared to have led to more positive outcomes for service users because responses were better co-ordinated. Nevertheless, there appeared to be frustration among social workers in some areas that social services still carried the bulk of responsibility for adult protection, which put additional pressure on them. The lack of clarity around who should lead on cases appeared to arise from different local interpretations. While the guidance states that local authorities (social services) should take the lead role in coordinating responses to and ‘joint working’ in issues relating to adult protection (DoH, 2000b), in some areas of England and Wales this appeared to equate to a view that social services were the lead agency (overall) and that therefore they (social services) should be wholly responsible for adult protection. Social workers considered that there should be more clarity about roles, so that all agencies would be clear about their own roles and responsibilities within adult protection. Engagement with service users also features here. What is apparent from the accounts of social workers is their wish to engage service users more fully, but uncertainty about how to achieve this effectively. Social workers were often conscious of the complexities of cases, where sometimes it was difficult for ‘victims’ to be identified or for ‘victims’ to agree with social workers that they were at risk of harm. Issues of personalisation and safeguarding also appear to be of relevance here. Although the topic of direct payments or individualised budgets and risk of abuse and exploitation was raised by a small number of the social workers interviewed in our study, this issue was not a major concern for the majority of our participants and hence was not a dominant theme in the analysis. This may well be because at the time the study was undertaken, most of the

practitioners interviewed were not working with service users in receipt of direct payments or individual budgets so consideration of the issue was not one that formed part of their daily working activity. Those participants who had experience in this area were more likely to raise concerns about how best to ensure appropriate safeguarding for service users within such situations. And at the time that the research was underway (2004–2006), such issues were just beginning to be raised within the field. Subsequent concerns about increased risks and possible rise in incidence of abuse has emerged from more recent work on direct payments and personal budgets and would be worthy of further attention and enquiry in future, specifically in relation to practitioners working within the field of safeguarding as well as those working more directly within personalisation and self-directed support.

Resource issues Although this is in many ways an expected plea when discussing social care, social workers argued that adult protection could not be ‘resource neutral’. In their view, for training to be developed and to increase awareness among agencies and the public, ‘adequate’ resources must be provided, although we do not yet know what these should be (Manthorpe, 2008). In addition, the ‘time constraints’ that social workers spoke of, might be addressed with further resources but they may also be affected by the changes to social care that are being promoted through the roll out of personal budgets (self-directed support). Leadbeater et al (2008), for example, suggest that social workers will have more time to focus on complex cases if they are less involved in care management (see Manthorpe et al, 2008). This assertion has yet to be fully tested, however, and the implications of this



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for such issues as safeguarding and risk management are as yet unknown.

These are high expectations for any legislation and some of these may conflict with social workers’ commitment to other valued legislation around areas of selfdetermination and the right to take risks.

Legislation Social workers considered that obligations to share information between agencies (as in child protection) arising from a statutory duty to work together would improve adult protection and reduce local variations in practice. Moreover, as reported elsewhere (Reid et al, 2008), the failure of policy and legislation to improve strategic partnership working until now is an important backdrop to the arena of adult protection and also strengthens the need for further legislation. A substantial number of respondents were hopeful that legislation would bring with it resources. The matter of legislation could therefore be seen as at the apex of the social workers’ discussions about the future of adult protection practice. Should there be a strengthening of the existing guidance to allow for flexibility? Or should legislation be passed which, among other elements, could require all agencies to work together and remove or amend professional confidentiality? The recent consultation paper by Action on Elder Abuse (2008) promotes further discussion on this topic, and also feeds into the review of No Secrets (DoH, 2008), which the majority of practitioners thought was much needed, if not overdue. Social workers’ views of legislative and judicial problems were complicated and related to case work experiences that involved the law concerning mental capacity, the Human Rights Act (1998), the Mental Health Act (1983), data protection and vetting and barring schemes. At another level they also seemed to believe that the very existence of a law would unlock resources, compel information sharing and require joint working between the agencies involved.

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Conclusion This paper has provided an insight into the views of social workers about adult protection practice. The research reveals some of the strengths that partnership working has brought to the adult protection process for social work practice, such as sharing information and determining responsibilities, and the exchange of different perspectives, which can lead to new skills for staff and potentially positive outcomes for service users from the social workers’ perspectives. The development of different definitions and interpretations of adult protection and a lack of knowledge among other professionals were seen as barriers to effective partnership working in this area. Adult protection may be moving from its formative stages to consolidation, but social workers noted their continuing reliance on the goodwill of other professionals to remedy lack of financial, time and human resources. Social workers’ perceptions of the continued divide between the NHS and social services were not surprising. While this study has only explored one side of this ‘divide’, it highlights enduring tensions, such as lack of shared ownership of the subject and the need to consider the relationship of adult protection within overarching human rights frameworks. Practitioner views that specific legislation is necessary to underpin such aspects as joint working between agencies, and requirements relating to information sharing, are timely and of relevance to the ongoing review of the guidance documents. Perceptions concerning increased service



user involvement within adult protection, at both strategic and operational levels are also pertinent here. The recommendations derived from the findings of the study have been fed into the review process. It is hoped that the outcomes of the review and consultation will successfully move adult safeguarding forward and that participation in the process will cover the spectrum that comprises adult protection.

References Action on Elder Abuse (2008) Consultation on Key Points Relating to the Review of No Secrets and In Safe Hands. London: Action on Elder Abuse. Association of the Directors of Social Services (2005) National Framework of Standards for Good Practice and Outcomes in Adult Protection Work. London: ADSS. Basit TN (2003) Manual or electronic? The role of coding in qualitative data analysis. Educational Research 45 (2) 143–154. Balloch S & Taylor M (2001) Partnership Working: Policy and practice. Bristol: Policy Press.

Acknowledgements All those who participated in the full study, either through completion of the survey in phase one, or within the case study sites in phases two or three as focus group or interview participants, provided invaluable contributions and deserve our thanks for their commitment to and enthusiasm for the study. We acknowledge the Department of Health Modernising Adult Social Care Initiative, policy research programme, for the funding received in order to undertake the study. The views expressed within this article are those of the research team and are not necessarily representative of the Department of Health.

Address for correspondence Lisa Pinkney Research Officer Centre for Health and Social Care Leeds Institute of Health Sciences University of Leeds Charles Thackrah Building 101 Clarendon Road Leeds LS2 9LJ Tel: 0113 343 0828 Email: [email protected]

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