Making Safeguarding Personal

Introduction

Making Safeguarding Personal, also known as MSP, is an approach that aims to keep the adult at the centre of safeguarding work and maintain a focus on the outcomes that are important to the adult. It is about developing a safeguarding culture that is person-centred and outcome-focused with practice that supports people to improve or resolve their circumstances.

What does this mean in practice?

This means that safeguarding is a process that is done with, and not to, adults. It prioritises giving the adult choice, control, and involvement to have a say in the safeguarding process. It requires staff to have skilled communication and to use professional or concerned curiosity to understand and achieve the best outcomes for the adults.

To be person-centred, find out and consider an adult’s:

• views to establish and maintain safety from harm
• values and beliefs
• wishes and preferences
• care needs
• support available and views of others involved, including family and friends
• need for information, in a way that is most accessible

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Why is it so important?

Nationally, Safeguarding Adults Reviews and audits have frequently told us that we need to improve in this area of practice. This is illustrated by the family involved in the West Sussex Safeguarding Adults Review in respect of Beverly, who asked that staff “reflect and strive to remember that within their individual roles, the most important person of a multi-disciplinary team, is the person themselves” (2023). If we view the adult as the expert in their own life, we will be much more likely to keep them central to safeguarding processes, and to achieve outcomes which are important to them (even if they’re not the outcomes that we would have chosen for them).

What are the key considerations?

By now, hopefully it’s clear that the most important person in any safeguarding process, is the adult at the centre of the process. As such, they should be involved from the very beginning, starting with asking them for their consent to report a safeguarding concern. Of course, there will be times when this isn’t appropriate, such as if it increases risk, but obtaining consent should be usual practice.

We should be giving the adult the opportunity, at every stage of the process, to say what they would like to happen. It’s important to note here that we must find opportunities to have these discussions with the adult alone, away from family, friends, or carers. This is to ensure there is privacy to disclose any issues and avoid any potential for others to influence or coerce the adult. You need to be aware of the possibility of ‘disguised compliance’, which is described in the West Sussex Safeguarding Adults Review in respect of Tom as “where a family member or carer gives the appearance of cooperating with professionals to avoid raising suspicions, to allay professional concerns and ultimately to reduce professional involvement” (2024).

This isn’t to say that we shouldn’t value the perspective of the adult’s family, friends, or carers. They may form an important part of the adult’s support network, and therefore may be able to provide important context to the adult’s wishes.

What happens if somebody lacks the mental capacity to participate?

There may be times when an adult isn’t able to give their views during the safeguarding process if they lack capacity. This means that they are unable to make a specific decision at that time, as a result of an impairment of the mind. This could include adults with a mental health condition, dementia, learning disability, or substance misuse. It’s important not to assume that an adult lacks capacity, though, and to be aware that capacity can fluctuate.

To support adults to be involved in the safeguarding process, you should provide them with information in a way that is most appropriate for them, at a time that best suits them (unless this would prolong or increase the risk). If they continue to lack capacity, you can seek the support of a representative for them. This is someone who can know and understand what their wishes and preferred outcomes would be if they were able to be involved in the process. This could be a family member or friend. If there is nobody suitable available, this could also be an independent advocate.

Person-centred practice

Person-centred practice means putting the adult with care and support needs at the centre of any process or decision in order to support their needs, goals, and outcomes to be met. It is central to a Making Safeguarding Personal approach. The following are key considerations for a person-centred approach.

Paternalistic practice

Paternalistic practice in safeguarding adults refers to an approach where staff make decisions for individuals, often with the belief that it is in their best interest, without involving or fully considering the person’s own preferences or autonomy. This can happen when staff assume that they know what is best for an individual, rather than supporting the person to make informed choices for themselves.

While it may be motivated by good intentions, paternalism can undermine an individual’s rights, autonomy, and dignity, potentially leading to disempowerment and feelings of helplessness. It is therefore important to reflect and check on how decisions are being made to ensure the adult is always involved in any decisions about them.

Protected characteristics

Protected characteristics are specific aspects of an adult’s identity, defined by the Equality Act 2010. 'Protection' refers to protection from discrimination. The practice of person-centred care must consider protected characteristics and how these may impact the adult’s care, and their views and wishes.

The following definitions of protected characteristics have been taken from the Equality & Human Rights Commission. It is crucial that staff are aware of these and that your practice does not discriminate against someone because of:

• age
• disability
• gender reassignment
• marriage and civil partnership
• pregnancy and maternity
• race
• religion or belief
• sex
• sexual orientation

Any discrimination based on the above protected characteristics is against the law and can be reported as a hate crime.

Discrimination

Discrimination can take different forms:

• Direct: when an adult is discriminated against based on the grounds of a protected characteristic and treated differently to another adult in similar circumstances.
• By association: when an adult is treated less favourably because they are linked, or associated, with someone who has a protected characteristic.
• By perception: when a person is discriminated against because they are thought to have a particular protected characteristic or are treated as if they do.
• Indirect: when a condition or requirement is applied equally to everyone but excludes an adult because they are unable to comply because of a protected characteristic.
• Micro-aggression: also known as subtle prejudice. This is a term used for statements, actions or incidents regarded as indirect, subtle or unintentional towards members of a marginalised group.

Duty of health and social care workers

The Equality Act 2010 places an equality duty on health and social care workers to eliminate unlawful discrimination. However, we all have a responsibility to consider the diverse needs of adults we are working with, minimising disadvantage, and ensuring the inclusion of under-represented groups.

Anti-discriminatory practice

Effective practice recognises and adapts to the diverse needs of individuals, and it is essential that services understand the implications of diversity in terms of equality and individual rights. Anti-discriminatory practice is an approach that seeks to reduce or eliminate discrimination and to remove barriers that may prevent people from accessing services.

Minimising discrimination in practice

The following tips will help to minimise discrimination in practice:

• Respect diversity by providing person-centred support.
• Treat adults as unique rather than treating everyone in the same way.
• Provide advice, information and support in a way which meets the needs and preference of the adult.
• Ensure you work in a professional and non-judgemental way; do not stereotype or allow your own beliefs to affect the care and support you provide.
• Refuse to initiate, participate, collude with, or condone discrimination and harassment.
• Proactively challenge and address discriminatory behaviours and practice.
• Use supervision to reflect on protected characteristics for the adults you work with, and to identify any issues and unintended/unwitting practice bias or discrimination.

Health and social care inequalities

Health and social care inequalities can lead to unequal access and experience of health or social care support. These can occur because of where an adult is born or lives, their job or income, or because of their age. Some examples which may lead to health and social care inequalities are:

• protected characteristics
• socio-economic status and deprivation: e.g., unemployed/low income or people living in deprived areas
• vulnerable or marginalised groups: e.g., Gypsy, Roma and Traveler communities, rough sleepers and homeless people, sex workers and people with learning disabilities
• geography: e.g., urban, or rural locations

Safeguarding during operational pressures or crisis

During times of operational pressures and crisis, previous Safeguarding Adult Reviews have shown that the needs of adults with care and support needs can be overlooked. It is acknowledged that on the whole, agencies and individual workers make every effort to put people who use services, first. However, Reviews have shown that in some cases, some actions and decisions made, retrospectively could have been different, and led to improved outcomes.

Staff need to ensure that at all times, including during times of pressure and crisis, that you ‘think safeguarding’ and ensure that Making Safeguarding Personal principals are adhered to.

Making Safeguarding Personal myths and realities

Myth 1: It is a myth that Making Safeguarding Personal means that if someone says they don’t want anything to happen then you can close the case and walk away.

Use your professional curiosity and relationship-based practice skills to ensure that someone is not pushing you away because they are influenced, coerced, or controlled by someone else. Persevere and establish trust to support people to minimise the impact of any unwise decisions on their health and wellbeing.

Myth 2: It is a myth that Making Safeguarding Personal is just a chat over a cuppa’ or “that MSP thing”.

Making Safeguarding Personal is about practice and culture change. Use the core principles of the Human Rights Act, Care Act and Mental Capacity Act to join up all parts of the system that can support the person at the centre of concern and resist seeing safeguarding as simply moving through a process.

Myth 3: It is a myth that Making Safeguarding Personal doesn’t bring perpetrators to justice because the person doesn’t want action and they will go on to abuse again.

Use Making Safeguarding Personal to stop abuse and neglect. Use your legal literacy and professional responsibilities regarding duties of care and public interest to ensure that anyone who could abuse others is properly dealt with.

Myth 4: It is a myth that Making Safeguarding Personal takes too much time.

Making Safeguarding Personal is time effective. It may take you longer in the beginning to explain everything and establish what the person wants but, in the long term, better choices will be made, protection plans will be more effective, and people will be supported to achieve the outcomes that matter to them.

Myth 5: It is a myth that it is not possible to use a Making Safeguarding Personal approach with people who lack mental capacity.

Making Safeguarding Personal is for everyone, including people who lack mental capacity. Use advocates and people who know the person to find out what the person might have wanted. Use the Mental Capacity Act to make best interests’ decisions in relation to specific safeguarding risks and involve all relevant parties.

Myth 6: It is a myth that the Making Safeguarding Personal approach cannot be used when a person refuses help.

Making Safeguarding Personal is or everyone, including people who refuse support. Use your skills, knowledge, and experience to check that someone else is not pressurising the person. Speak to the person in private and think about why they may be turning down help. Build up trust, work together with someone they know well; someone needs to keep trying and that could be you.