Adult safeguarding – introducing the concept of insignificant harm

The proposal is that the threshold for adult safeguarding should be “significant harm”, rather than the lower “harm” threshold recommended by the Law Commission. Mithran Samuel at Community Care (@mithransamuel, @ComCareAdults) debates the wisdom of this (‘Will safeguarding threshold leave adults at risk?‘) with reference to arguments aired at their Adult Protection Conference, and I note reference to the Department of Health favouring the same threshold as for children.

Good for them! I hope it was more than a quest for neatness and simplicity. I venture to suggest a parallel with the children’s significant harm threshold is legally and morally right.

I fear being torn off my high horse whenever I write favouring less intervention. Many can understand that our human rights, forged in the aftermath of a long and bloody fight against totalitarianism, are largely rights to be left alone by the State. But I write from within a profession that epitomises State intervention in private life; and many are comfortable with that and uncomfortable with anything that might limit their right to intervene.

Before the more controversial bits – why harm is not always that harmful, and the medicine isn’t that great anyway – a little reminder of what the structure for children actually is. It is, I venture to suggest, well-thought out, balanced and detailed, which is why it has stood the test of time.

  • First, there is a basic distinction between children in need and those at risk. The latter may be in need but the former may not be at risk. Children in need have a right to an assessment, and can receive preventative and support services, with consent.
  • Second, the definition of a child in need (section 17(10)) closely foreshadows the definition of harm found elsewhere in the Children Act (e.g. section 31(9)). The extent of the overlap is such that a child in need and a child at risk of harm are widely drawn definitions; and there is a “general duty” – not a duty owed to each individual child – “to safeguard and promote the welfare” of this group.
  • Third, we next have the ‘tripwire’ of the significant harm threshold which moves us from prevention and support with consent to compulsory intervention. Before we trip that wire, and as the procedure for deciding whether the wire is tripped, we should have tried engaging with the family (Working Together para 5.38 and para 5.41).
  • Fourth, significant harm is defined in such a way that it is clear that not all harm is significant (Working Together para 1.26 to 1.31, especially para 1.28); from which it necessarily follows that not all harm warrants or permits compulsory intervention.

There is nothing there that could not, with great wisdom, be replicated in adult safeguarding.

Harm is not always that harmful

Squeals of outrage? Am I sanctioning low level abuse? But it’s true!

Remember that the definition of harm is widely drawn. So widely drawn that (dare I say this?) the chances are that we all harm from time to time.

Sometimes we harm because as parents we manage risk rather than prevent it. We decide to let our children run ahead and hey, they fall over and injure themselves. We allow them to keep abreast of world events, and they are traumatised by the atrocities they discover.

Other times, we harm because as human beings we are fallible. We are too tired or ill to protect from harm. We lose it. We have accidents. We concentrate on our own work or leisure and overlook the consequences for those we care for.

Other times still, harm is the consequence of life circumstances outside of our control. Poverty. Discrimination. Unemployment. Physical and mental health issues. Poor housing.

If you want to sanction harm as the right threshold, you probably want to say, that’s not what I mean by harm. But it is encompassed in the definition of harm.

And rightly so. It is right that you can access services in these situations. It is equally right that you can resist compulsory intervention.

The medicine isn’t that great anyway

Another uncomfortable truth? Faith in State intervention must surely be predicated upon faith that the intervention, and the medicine, will make us better. Eileen Munro ([2007] ‘Confidentiality in a preventive child welfare system’ in Ethics and social welfare, 1 (1). pp. 41-55) argues in respect of extending compulsion for children beyond the ‘significant harm’ threshold,

There are three key criteria to judge a screening programme against: predictive accuracy, treatability, and the level of damaging effects.

Predictability…  In predicting risk of child abuse and neglect, existing risk instruments lead to an unacceptably high level of false positives (families inaccurately deemed to be high risk) and high level of false negatives (dangerous families wrongly judged safe)…

Treatability… There are undoubtedly some grounds for optimism in judging our ability to offer effective help that improves children’s outcomes but success, while significant, is modest….  To judge whether these were worth providing, we would also need to know the cost per child treated and to consider how else that money might have been spent…

The level of damaging effects… Overall, the case for a screening programme is not compellingly made.  It carries uncertain benefits and certain losses in that it erodes people’s privacy and right to confidentiality…  there is a case for trying the less intrusive option first and seeing what progress can be made on a voluntary basis – finding out whether adequate resources can be provided and testing the effectiveness of the interventions offered.

Again, this holds good for adults. Significantly, note what the ‘certain loss’ is – it erodes people’s privacy and right to confidentiality. Frequently in social work we would describe that as a positive benefit. These annoying rights get in the way of protecting people, allow people to get away with harm.

Wrong. Unless you see the State as inevitably benign – a view for which history and geography offers little support – then these rights forged in the aftermath of totalitarianism are good in themselves as a bulwark against the State.

Moreover, it is positively beneficial to develop and grow co-operative and preventative work. If it is compulsion or nothing then social work will frequently be resented and little trusted. People will choose not to come forward for help. People will resent if the only route to services is being on a new ‘at risk register’. Conversely, a growth in trust that we can bring about positive change will lead to a growth in the opportunities to do so.

Because, finally, the significant harm threshold is not about who gets services or not. It is not about whether you need evidence or not. It is not about sanctioning low level abuse. It is simply a good mental discipline that forces you to justify that moving from co-operation to compulsion was warranted by something that was significant.

Allan Norman (@CelticKnotTweet) is a registered social worker and a solicitor at Celtic Knot – Solicitors and Social Workers.

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4 thoughts on “Adult safeguarding – introducing the concept of insignificant harm

  1. No howls of outrage from me. In fact, I think what you’ve said is eminently sensible.

    If the benchmark was “harm” rather than “significant harm”, I’d have to do a child protection referral every time a parent smacks their child. I’m not in favour of smacking, but I also wouldn’t want to report every instant of it to social services, and I’m sure social services wouldn’t want me to either.

    In a similar vein I notice that one of the proposed libel reforms is for the defence of “truth” to be changed to “substantial truth” – presumably to reduce the risk of people being financially ruined by tortuous legal arguments about the precise meaning of this or that word.

  2. This makes a lot of sense – it’s very hard to get a handle on everyone’s definition of “harm” and in my line of work, advocates sometimes struggle with this. Whilst I appreciate that it would be very difficult to come up with a comprehensive list of “significant harms” and a lot ends up being left to professional judgement, clarification around this would be really helpful. I meet some people who get really frustrated that they raise safeguarding alerts that don’t meet the threshold to go into safeguarding for adults, but are then at a loss as to how to then resolve the issue in a sensible manner. I’ve worked on cases where the threshold isn’t met, so the matter isn’t dealt with at all, which results in me hopping up and down trying to get relevant parties to solve service delivery issues rather than just going “oh – it’s not safeguarding so we don’t have to do anything.” Thank you for this piece. I enjoy the blog!

  3. Pingback: The Court of Appeal ruled yesterday on the scope for adult safeguarding « The Not So Big Society

  4. Pingback: The case for a significant harm threshold for adult safeguarding | Adult Care Blog

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