Abstract
Reviewed by: Hilary Brighton, Safeguarding Adult Coordinator, England
This book will be of interest to policy makers, senior practitioners and academics as one of the aims is to ensure that the theory of, and practice in, safeguarding older people influences policy. As an active practitioner, I found the book beneficial in strengthening my knowledge and awareness of how and why the policy I work within has been developed. It was also refreshing to read about and be encouraged to practice professional skills in an environment where increasingly Health and Social services are being target-driven as opposed to person-centred.
Angie Ash argues in Chapter 2 that work within safeguarding older people needs to be theoretically based and with critical perspectives to ensure that interventions are not harmful to the older person. She also suggests that critical thinking is necessary to challenge assumptions and to encourage questioning, both of the situation and the worker. Chapter 3 comments on the definitions, prevalence and risk factors of elder abuse and domestic violence. The author asks an interesting question as to whether, in practice, abused older women are seen thus or as ‘battered women’, and then discusses the incidence of male victims of domestic violence. This chapter ends by considering both the impact and effectiveness of interventions in these situations.
In Chapter 4, the author considers Adult Protection law and policy in England, Wales, Northern Ireland and Scotland, the development and impact of personalisation and individualisation and their place within safeguarding policy and practice. In Chapter 5, Ash considers Lipsky’s work (1980) on street level bureaucracy – that the practice and decision-making of health and social care professionals within safeguarding then becomes policy. Discretion therefore is shaped by both the practitioners being encouraged to be decision-makers, especially if there is no clear policy to follow. Practitioners strive to follow the concept of ‘choice’ and ‘control’ but these are often overshadowed by the reality of large caseloads, dwindling resources and vague and/or unworkable policy. As a practitioner, this chapter had particular resonance for me as it gave focus to the reality of working within the safeguarding arena as it is today.
Again, from a practitioner’s viewpoint, Chapters 6 and 7 were fascinating in providing an overview of a Social Services Department in Wales, but looking specifically at the difficulties workers faced when attempting to implement safeguarding policy. The chapter is divided into five sections which consider issues such as how adult abuse is recognised, the organisational culture (which looked at challenging ‘poor practice’ within services), the dichotomy between needs-led and resource-led Departments and the ‘Dilemmas faced’ – situations where workers consider issues such as capacity and protection and the balance between procedure and professional autonomy.
Chapter 8 discusses the issue of complicity raised within the study discussed previously and why, for example, workers sometimes ‘turn a blind eye’ (p. 121) to poor or inadequate care, and where organisations focus on targets rather than service user outcomes. Chapter 9 discusses the ethics of adult abuse and then considers ‘recognition’ – where workers do or do not see abuse, using Honneth’s argument that not recognising people’s situations can be abusive in itself. The last chapter provides a conclusion which reasserts the author’s argument that in order to safeguard older people there is a need for ethical public policy which supports workers, rather than systems produced in response to failings and complaints.
This was not an easy book to read and is not a safeguarding manual to be kept on practitioners’ desks for quick reference. However, Angie Ash makes some powerful and interesting points about the present systems employed to (or not to) safeguard older people and what needs to be done in order to improve services. Certainly the book heightened my awareness as a ‘street-level bureaucrat’.