Modern social work aims to keep people safe. But in practice much of what we do in the name of safety seems to increase risk. How do we really keep people safe and what is the role of social work?

1. Safe &
Sound
Reflections on the ambiguities of safeguarding
Talk for social workers at Hertfordshire
University by Dr Simon Duffy on 2nd April 2014

2. What is safety?
• We all want to be
safe
• And I’m not sure
about being “risk
enabled”
• But I don’t just
want to be safe.

3. Where are we safe?

4. “A report by an United States
healthcare advocacy
organisation Healthgrades
Inc. found that there were over
700,000 “patient safety events”
affecting 667,828 Medicare
beneficiaries from 2007 through
2009. These events resulted in
79,670 patient deaths and cost
the Medicare program nearly
$7.3 billion. [Patient Safety in
American Hospitals March
2011]”
Not in
hospital…

5. Not in residential care
[Source: Action on Elder Abuse Data - relative risk of abuse]

6. So why do we keep falling back
on the institutional response?

7. “It is not easy. What do we do when we don't
know what to do? I want that guy out of sight,
out sound, out of mind… The situation keeps
cropping up in our society, when no matter how
liked, esteemed or loved, some people become
insufferable to others. No one they know wants
to live with them. They are not breaking the law,
but they arouse in those around them such
urgent feelings of pity, worry, fear, disgust, ager,
exasperation, concern, that something has to
be done. A social worker or psychiatrist is
'brought in'.”
R D Laing

8. Institutions didn’t come into
existence because they were
safer than communities. Instead:
• The loss of jobs and family
structures in the countryside
• Industrialisation and the lack
of work and support
opportunities in the towns
• Eugenic panic and the fear of
difference and the fantasies of
racial purity

9. We know only too well that
institutions are unsafe.

10. Frances Enquiry:
Connor Sparrowhawk drowned
in a bath in an assessment &
treatment unit.
Torture at Winterbourne View, a
specialist residential care unit
“There was a lack of care,
compassion, humanity and leadership.
The most basic standards of care were
not observed, and fundamental rights to
dignity were not respected. Elderly
and vulnerable patients were left
unwashed, unfed and without fluids.”

11. Even for people in ‘community care’ services
institutional practices continue and safety is
often imperilled in the name of safety.
1. Michael lived in residential care home.
2. He was threatened by the police, even placed in the
cells, after he got angry because he was not free to go
to the ice cream van in his street.
3. Yet he walked home everyday from the day centre - by
himself - because the day centre was ‘boring’.
4. And his mum tried to quietly teach him independence
skills - although worried that she’d be told off by social
worker.

12. Safety sometimes does demand control - but
only in the most extreme of circumstances and
after considering all the other possible options.

13. There is an everyday totalitarianism for
many people living in institutional care.
Freedom is replaced with order and control.
Love is replaced with management.

14. But it’s not just institutions that are unsafe…
Communities can be very unsafe too, especially
for people in real poverty.

15. These are 44 women working with WomenCentre in
Halifax. Each column represents one woman and the
combination of problems with which they have to battle

16. WomenCentre have a
remarkable success rate in:
• Reducing abuse and
domestic violence
• Keeping children safe
• Keeping women out of prison
• Helping women get their lives
back on track
• Increasing mental health
• and much more…

17. WomenCentre’s success is built on a
sophisticated and holistic model of support

18. They have also developed and led critical strategic developments to
prevent abuse and family breakdown across the whole community.

19. So does modern social work support the
kinds of relationships between
professionals and citizens which really
increase safety?

20. Care management systems do
not always seem as flexible
enough to allow the right mix of
hands on work and
empowerment:
• The emphasis continues to be
in placing people or setting up
packages of support.
• People recognise that others
can - sometimes - take
leadership roles - but the
system doesn’t support it.
• Those who need the most
support often lose out as time
is spent working with others.

22. Patrick left the institution with the most
severe reputation for dangerous
behaviour. So what made Patrick safe?

23. • Independent living for people
with very complex needs
• Managed personal assistants
- recruited just for you
• Individual Service Funds -
managed flexible budgets
• Totally bespoke support -
designed around you
Getting the
support right

24. A. individualise everything

25. B. find creative solutions

26. C. focus on citizenship

27. Practical guidance to help people
develop their own support solutions
around:
1. Planning
2. Decision-making
3. Money
4. Housing
5. Help
6. Community
7. Relationships
Get practical

28. Does modern social work develop the right
kinds of skills to enable social workers to
create community-focused support
solutions?

30. Many people
feared that self-
directed support
would increase
the risks people
face. But it seems
to leave people
feeling safer.
Personal and
control and well
correlated. It is
being in the
control of others
that is most risky.

31. 1. Capacity - assume I can decide
2. Specificity - don’t generalise any
incapacity
3. Selection - let me pick any
representative
4. Suitability - find a suitable person
5. Best interest - pay attention to
what matters
6. Involvement - I can still be involved
7. Review - things change
But supporting
freedom is vital

32. Does modern social work
understand and know how to
support freedom effectively?

33. A failure to support effective advocacy by families seems
to have been a common pattern for the young people
who ended up in Winterbourne View and similar places.

34. On average each person had been in
10 different institutional settings,
including:
Residential schools (n=3) Acute
hospitals (n=3) Residential colleges
(n=1) Low secure hospitals (n=6)
Specialist facilities (n=6) Residential
homes (n=5)
All six had been victims of abuse,
including:
Neglect (n=2) Sexual abuse (n=6)
Physical abuse (n=5) Financial abuse
(n=1)
We seem to be
commissioning
crime and abuse

35. O’Brien’s model of good support sees
safeguarding as a critical element of community
connecting. Isolation is the biggest danger.

36. The emergence of Local Area Coordination
reflects a desire to refocus energy on
preventing crisis and enabling citizenship.

37. Remember most
of the people in
someone’s life
are and should
not be staff.
Surrounding
people with
paid staff and
regulating paid
staff is not the
key to safety.

38. Does modern social work know
how to work with communities
to keep people safe?

40. For more information:
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