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Safeguarding: balancing self determination and best interest

28th October 2019

Head to head: Judith Davey and Nicola Youens discussing “Does advocacy have maximum possible impact?”

Judith: Reflective practice is an important part of everything we do. That way we learn, improve and deepen the outcomes for the people we work with. Nicola (our Head of Service Delivery) and I are talking about impact and outcomes.

As a sector, have we got the balance right between self determination and best interest in relation to safeguarding? If we don’t get the balance right, we could be contributing to creating impact that’s suboptimal. What do you think?

Nicola: Great question. As a sector, I’m not always sure we get the balance right. And without a shadow of a doubt, that will affect impact and outcomes. Let’s consider a scenario.

Mary is being supported by a Care Act Advocate about her care and support, as her advancing dementia means that she needs more support. She mentions that her husband/carer gets frustrated with her and sometimes lashes out, but she understands why. She doesn’t want anyone to know and she certainly doesn’t want anyone to talk to her husband about it. It is something she just needs to “put up with”, as she loves him and doesn’t want to risk upsetting the status quo.

From a traditional safeguarding perspective, our approach would be “I must report this to the local authority”. That’s absolutely the right thing to do. I know from my experience in the health & social care sector (including roles as a provider of training for social workers and from my work as an advocacy Quality Mark Assessor) that reporting is our first consideration. However, before taking action, we must first consider what Mary wants and how we can balance that with keeping her safe. What outcomes does she want? How can advocacy make the deepest impact?

Judith: Yes of course. In the spirit of Making Safeguarding Personal, we want to support her to feel in control of decisions about her life. That includes how Mary wants to be supported to be safe. And feel safe. But how do we do that?

Nicola: In an ideal world, she wants him to stop lashing out at her but she doesn’t want to offend him, and she understands he is under a lot of pressure as he never gets a break from caring for her.

We could explain to Mary that we have a duty to report it to the local authority. Or we could explain we won’t report it to the local authority if she doesn’t want us to. And that would be ok, assuming we have no reason to believe she lacks capacity and there is no-one else at risk. But there’s a third option, and potentially a better one.

Judith: Interesting. Tell me more…

Nicola: We need to allow Mary to maintain her self-determination, while at the same time allowing professionals to have assurance that she’s safe. We should support her to know what her options are and to know what would happen if she asked the local authority for support.

It might be that through discussion she agrees that she wants support from social services to reduce the pressure on her husband. We would be clear that we could call the local authority together, clearly communicate what her wishes are, and what she doesn’t want to happen, make sure she knows that she can stop an action if she wishes and that we can support her through this. In this way, she is empowered to know what her options are, feels in control of any action, and can manage her anxieties about offending her husband.

The impact of this type of approach enables her to be safe and keep the thing that is most important to her – the relationship with her husband.

Judith: Food for thought. So what you’re saying is that, as a sector, we need to be more thoughtful in trying to find an optimal outcome that balances self determination and best interest. I can see working in this way will really help in achieving better outcomes by balancing initially irreconcilable considerations of autonomy and best interest.

And now the killer question – what does the sector need to do to incorporate these sorts of considerations in our day-to-day work?

Nicola: I think the sector needs support, coaching and training to make sure advocates have the confidence that they are doing the right thing for the person and will be supported by their organisation. Anyone and everyone involved in advocacy and safeguarding needs to consider the following question:

“How can we do this safely in the most person-centred way to make sure the person feels in control of decisions about their life?”

Judith Davey, Chief Executive, The Advocacy Project
Nicola Youens, Head of Service Delivery, The Advocacy Project

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