Let’s change the approach to Self-neglect &

hoarding in Norfolk: A seminar & call to action

Working together to make Norfolk safer

31 October, 2019

Magpie Suite, Dereham Football Club, Dereham

Quick housekeeping ….

❖ break | toilets | fire alarm

❖mobile phones

❖ photographer - Bill Smith

❖ social media - @NorfolkSAB

❖ hashtags #selfneglect #safeguarding

Updates ….

Current position on self-neglect & hoarding work

NSAB strategy updates

Specialist Self-

Neglect and

Hoarding Service

Sarah Young

Chris Scott

Overview of the work done to date …..

Pilot service

- A 3 month pilot (between Mar and June 17) was developed with Stonham

Home Group providing two dedicated workers who provided support to

people identified with self-neglecting behaviours.

- 10 cases were referred to this pilot and Stonham actively worked with

seven people/ families

- This dedicated support had a positive impact on at least 2 people, with

another 3 people showing early signs of progress.

- It recognised that labour intensive support is needed, often requiring

several visits to develop trust with the individual

‘establishing a positive relationship with a self-neglecting person requires

considerably more effort. Frequently there is no substitute for devoting

considerable time on an ongoing basis to the gradual development of a positive

relationship of trust (Black and Osman, 2005; Lauder et al, 2005a), although this

presupposes not only the worker’s willingness to do so but also their availability,

which may depend on resource pressures, caseloads and organisational priorities

(Black and Osman, 2005; McDermott et al, 2009).’

Cited in (Braye, S., Orr, D. and Preston-Shoot, M. (2011) Self-Neglect and Adult Safeguarding: Findings from Research.)

National picture (2-5%

of people living with

varying degree of self neglect

and/ or hoarding)

Growing issue in Norfolk

Care Act 2014

Fire Risk

Why….

Safeguarding Adult

Reviews

Supporting vulnerable

people

Survey feedback

- 141 people responded and it identified that the majority of practitioners were

working with 1-2 self neglect and hoarding cases per month.

- Of those 141 people, 131 practitioners told us that SN and Hoarding cases can

take up to 10% of their time, 98 said SN and Hoarding cases take between 11-

40% of their time

- The main challenges when dealing with self-neglect and hoarding cases was

cited as lack of engagement from the person involved, followed by lack of

engagement from other professionals: lack of time was also cited.

Model of support: Possible approach to supporting

people who self neglect and/ or hoard

Multi Agency input and supportIn

div

idu

al id

enti

fied

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d

Step oneIndividual agency support

Step twoEarly Help Hub discussion to identify

multi-agency support

Step threeSpecialist support through

a Self Neglect and/ or Hoarding service

Proposed service –Support workers,

Therapeutic Support

The Aim

The Learning

Learning through the PHD research

Business case….

Produced by the Task and Finish Group

Multi-Agency support

Generate support, talk to

your peers, stakeholders in

your own organisation

Seek funding from multiple agencies and commission a

service

Contact one of the team to find out

more

Next steps….

Sarah Young (YourNorwich Operational Lead) – Email: sarah.young@norfolk.gov.uk

Chris Scott (AD Community Commissioning, ASSD) – Email: chris.scott@norfolk.gov.uk

Contact us

Social Enterprise Trading for Good

Our aims • To create warmer, safer, healthier homes

in Suffolk• To improve the future life chances of

young adults

Our Team

Creating warmer, safer, healthier homes in Suffolk

Our services• Home and Garden Decluttering • Breathing Space Small Jobs for family carers and

others• Homeward Bound Hospital Discharge Service • Downsize to move • Supported house clearance • End of tenancy clean• Information and Signposting• Raising Awareness and providing training to other

professionals

Creating warmer, safer, healthier homes in Suffolk

Hoarding Whose problem is it?

Feedback

“Many, many, thanks for the work you have done so far. I really don't know what I would have done without you. I had no idea where to start and was completely overwhelmed with the scale of the work needed. You were a complete rock for me and guided me through a very difficult time with sensitivity and care. I am now able to visit my dad's house and breathe again”.

Customer

Working with you has definitely shown a character change in ‘B’, and it has helped Mid Suffolk District Council to overcome a regular problem that landlords face with their tenants when maintenance is necessary but it impedes on people’s lives. Tenants don’t want to change and this causes multiple tenancy related issues. But thanks to your hard work, on this occasion the problem has been resolved easily. Once again, to you and all of your team, thank you.

Referring Professional

What you did really helped us to cope with all that has happened.

Patients family

Improving The Life Chances of Young Adults

37 young adults re-engaged with learning

17 young adults provided with work experience

11 young adults provided with real paid employment

“I started induction today for a job with B * (a large, well known company). Thanks for the opportunities you gave me, it means a lot, you have changed me a lot and had faith in me and that means a lot.

If it wasn’t for you, I don’t know where I would be.

Thank you I am very grateful to you.”

L.. Care Leaver 2019

“Having a job has made a massive difference.I expected that, but it has changed everything in areas of my life that I didn’t expect.

It has also improved my relationships. Finally, I have more money. I’ve been able to take my partner out for a meal and a drink. I was able to pay for that. It made me feel like a man.Working isn’t just about the money, it’s about worth.”

D 2019

Olive QuintonFounding CEO

01473 34530107745215114

www.lofty-heights.org

Coffee

NSAB - 31.10.19

Norwich City Council

Case study

Grant Lockett, Tenancy Services and Income

Manager

Points for discussion

➢ Who would you have communicated with to resolve the issues?

➢ What interventions might have been undertaken?

➢ Which agency might have taken the lead on those interventions?

➢ Which agency might have funded or resourced those interventions

➢ Would we do things differently under the County Self Neglect and Hoarding Strategy?

➢ Which agency might manage the tenant’s support needs going forward?

Sue RobinsonHelp Hub Manager

February 2019

The Journey

• It started with the need to identify vulnerable residents due to risk of flood in Great Yarmouth.

• Help Hub we experiencing lots cases coming through our collaboration time.

• Cases were ‘stuck’ or poor/non-engagement.

• Increase in professionals confidence to discuss worries /concerns and not hold on to cases.

• To actively encourage professional curiosity to find creative/alternative solutions

• Culture of sharing – is anyone else working with…. As a way to start support

• Culture of multi agency working which reflects the needs of the Locality

• Since New Year 2017 monthly hoarding meetings

• Using the Norfolk guidance and scaling tool

A word on self neglect:

• Take some time to reflect on ‘Self Neglect’ and its relationship with hoarding

• How does and individual or family get to the point where we become aware that intervention is needed?

• The old saying ‘standing in someone else’s shoes’! • Is it really possible that they have never seen anything different ? • Do they actually know how to clean, look after themselves ? • Many solutions are simple. We need to use this more. • Increase in professionals confidence to discuss worries /concerns

and not hold on to cases. Culture of sharing – is anyone else working with….

• Increase of professional curiosity. Ask questions.• Work together with community partners to find

creative/alternative solutions• TAKE AWAY MESSAGE: non engagement doesn’t mean support

isn’t needed.

Collaboration in action: Mental Health, Adult Services, Police, community connectors, Estates, DWP, Early Help Hub.

What Does Success Look Like ?

Some Successes:

Turning a ‘hoarding habit’ into a positive activity: • Recycling• Caring for pets/dog walking• Clothes and charity shops• Shopping and food banks

• Making sure all associates needs are met• Bereavement• Significant change• Loneliness• Mental Health – OCD, CBT • Debt and health issues

• Assessing each case individually – no one size fits all.

• Clearance can work in some cases.

• Finding ways for long term support

The future:

• Hoarding is one of our five areas of priority for the Hub

• Continue to work with Adults Safeguarding Board to support county work both in terms of research and how cases are managed

• Developing a database to be able to monitor cases, interventions and outcomes

• To demonstrate what success can look like and time frames

• Continue the journey…. To develop a common language and understanding across agencies.

• To demonstrate the strengths of multi agency blended approach

• TAKE AWAY MESSAGE: non engagement doesn’t mean support isn’t needed.

Sue Robinson, Help Hub Manager, Great Yarmouth

Sue.Robinson@great-yarmouth.gov.uk

01493 846375

A Single Service~900 talented people, focused on serving the

communities of Norfolk and beyond

Working together to

reduce harm &

Save Life

264.5 FTE Wholetime520 FTE Retained

81.3 FTE Non-Uniformed

23 FTE Control

A Person Centred Approach to Fire & SafetyNorfolk Fire & Rescue Service

Regional and National Fire and Rescue Services

Services delivered by working with a wide range of partners:

Co – operative Partnership Picture

Incident activity (all)

Fires in the Home

11 7

6848

710

66

41

0

50

100

150

200

08:00 to 19:59 20:00 to 07:59

Nu

mb

er

of

casu

alti

es

Time of day

Accidental dwelling fire casualtiesby day and night

01/01/2013 to 31/12/2018

Went to hospital,injuriesappear slight

https://www.youtube.com/watch?v=hMtjGfr0tYs

Cause of Fires in the Home

Prevention & Protection Strategy

5 key principles• Reduce the volume & Harm from all

incidents• Early intervention for most

vulnerable• Young People education &

development (CC, PT, Cadets)• Building Safety Visits & Inspections• Stronger joint partnership working &

evidence-based outcomes

Person Centred Approach to Prevention

Challenge - Engaging with our Communities

NFRS‘Timing’

Letting InLetting OutLetting Go

Shared Protection Duties

• Know Your Building & Escape routes

• Know your neighbours

• Respect shared escape routes

• Close doors behind you as you leave

• Keep all exit routes clear of clutter

• Know How to raise the alarm

‘Get Out Stay Out Call Us Out 999’

Do not:

• Make assumptions or judgements about a person’s reasons for hoarding or whether they suffer from a mental health

condition.

• Use judgmental expressions, either verbal, e.g. referring to clutter as ‘junk’, or non-verbal, e.g. shaking your head or

tutting.

• Tell the person what they should and should not keep, or how they should dispose of possessions.

• Touch belongings without permission.

Do:

• Seek to improve understand the hoarder’s perspective by asking interested questions & build connection

• Match the person’s language e.g. referring to items as ‘collections’ or ‘things’.

• Explain the Home Fire Risk Check process & severity of Risk + Consequences clearly.

• Work with resident to agree joint of solutions

• Give clear and direct advice following the ‘top tips’ to reduce the risk of fire.

• Stay focused on shared solutions that benefit the person, neighbours, partners & communities.

Top Tips

Combine Personal, Home & Behavioural factors in an assessment:-

Hoarding & Clutter

• No lighting candles or tea lights (use LED flameless candles)

• Do not use portable heaters, gas hobs or open fires to heat the home

• Smoke outside the property, ensure metal means of discarding items

• Develop a specific escape plan ( 2 exits) both accessible to open air

Fire

• Smoking safety and alternatives

• Naked flame safety (candles, open fires)

• Cooking safety

• Heating safety

• Bedtime routine

• Smoke detection & escape plan

Others

• Slips trips and falls

• Loneliness and well being

• Safeguarding

• Fuel poverty

• Lifestyle challenges, smoking, eating, exercise, community connections (signposting or

referral)

Top Tips

Top Tips – ‘so what………

Evaluation & Outcomes

Safe and Well Thetford PilotService evaluation May 2018

67% of those at risk accepted a referral to a falls clinic.

59% of those who accepted a referral attended the falls clinic

appointment.

Thank you for listening

Questions?

Positive actions ….

Topic Action

NSAB email alerts Sign up – email through the contact page of the website

NSAB safeguarding policy

When published, review your policy to make sure language is correct

Locality Safeguarding Adults Partnerships (LSAPs)

Make a link with your local partnership

NSAB events Watch the website for details & sign up

Positive actions ….

Key contacts

NSAB Board Manager

walter.lloyd-smith@norfolk.gov.uk

Norfolk Safeguarding Adults Board

http://www.norfolksafeguardingadultsboard.info/