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Introduction
In England and Wales Local Safeguarding Adults Boards (LSABs) have not been required to conduct or publish serious case reviews (SCRs). Many have adopted guidelines published by the Association of Directors of Social Services (ADSS, 2005) but these are only advisory. Consequently, some uncertainty has existed on what circumstances should trigger such reviews and practice is variable in the absence of central government guidance on thresholds, inter-agency co-operation, resourcing, media management, timescales and publication (Manthorpe and Martineau, 2012). No database exists of commissioned and published SCRs, which makes collation and analysis to facilitate learning and practice development difficult (Braye et al. , 2011; Manthorpe and Martineau, 2011). Those SCRs that are published, however, if only in executive summary form, can cast considerable light on safeguarding practice.
The Care Act 2014, which reforms adult social care and adult safeguarding law in England and Wales, places a duty on LSABs (henceforth constituted on a statutory basis) to carry out and publish safeguarding adult reviews where serious abuse or neglect has contributed to the death or serious harm of an individual, and where there is reasonable cause for concern about how professionals and agencies have worked together. LSABs will also have a power to undertake reviews in other circumstances, the purpose throughout being to learn lessons and improve future practice. This responds to the need to learn from challenging cases and to channel that learning from individual incidents into the wider service context and professional network in order to improve standards and governance (Brown, 2009).
One of the key challenges in adult safeguarding is ensuring the wellbeing of adults where risk arises from self-neglect rather than from a third party, particularly where they do not wish to engage with the state's protective agenda. Research has identified that health and social care professionals often find self-neglect cases of this kind to be enormously challenging and fraught with ethical and legal dilemmas, particularly when adults are judged to have mental capacity to refuse support (Braye et al. , 2011, 2013). Practitioners report feeling exposed when coping with disappointments and anxiety, and uncertain how to balance a duty of care with a person's right to private life. Organisational systems may not clearly locate strategic responsibility for complex cases that...