Evidence Review - Adult Safeguarding

This review was commissioned by Skills for Care's Workforce Innovation Programme which explores how people's care and support needs change and how the workforce has to adapt to meet the challenges that change can present.

The key questions that the evidence review aimed to address with reference to adult safeguarding and the social care workforce were:

• What are current reported practices to support workforce intelligence, planning and development?
• What works, and what does not work, in current practice to support workforce intelligence, planning and development?
• What are the key characteristics of effective practice in workforce intelligence, planning and development?
• What are the gaps in the evidence base?

The review followed the Civil Service rapid evidence assessment methodology. A wide range of databases, web-sites and grey literature were searched and screened, using search terms related to adult safeguarding, adult protection and workforce, staff and training.

Overall, much of the evidence on workforce and adult safeguarding is based on a limited number of studies and cases. Much of the work reviewed was of little specific relevance to the social care workforce. Most studies were qualitative, concerned with obtaining views and experiences. Control groups were rarely used for comparison. Much of the grey literature was focused on good practice and guidance. The evidence came mainly from the UK, as the policy and organisational context for overseas studies was so different.

Ten broad themes were identified:

- Policy in practice
- Incidence and prevalence
- Risk factors
- Staff perceptions and understanding
- Effect on staff
- Prevention
- Models of care
- Risk assessment and personalisation
- Deprivation of Liberty safeguards and Mental Capacity Act
- Serious case reviews and lessons learned

The evidence review indicates the need for better staff understanding of what constitutes abuse and how best to respond to it. But there is a serious lack of robust evidence about how best to equip staff with the knowledge and skills required to recognise and respond effectively to abuse in order to safeguard adults at risk, and equally little known about which approaches to prevention and models of care are most effective.

The introduction of personal budgets and personalisation, the Mental Capacity Act, Deprivation of Liberty Safeguards and Lasting Power of Attorney, create new workforce challenges. Serious Case Reviews provide a potentially valuable source of evidence of what does not work. However, analysis has been relatively unsystematic in the absence of a national database.

In conclusion, the evidence review identified a wide range of research studies both quantitative and qualitative but found only a couple of systematic reviews. Nevertheless, it endeavoured to identify a range of relevant evidence about current practice, what works and what are the key characteristics of effective practice, and where the gaps in the evidence base exist in relation to adult safeguarding and the social care workforce.