Risk, safety and safeguarding: understanding and application of concepts and implications for integrated care services

Introduction

Keeping individuals safe from harm and exploitation is a clearly articulated goal within health and social care sectors. Two key terms associated with achieving this aim are safety and safeguarding, and these are commonly used in health and social care guidance and practice. Guidance refers to both these terms and outlines the steps providers need to take to ensure that they comply with regulations and manage risk appropriately. In practice, however, there appears to be little knowledge or exploration of how these two terms may be understood across different care contexts.

Objectives

This review aims to redress a gap in the literature by exploring, through a scoping review of evidence, policy and guidance documents, the extent to which definitions, discussions and practice of safety and safeguarding across different care sectors are shared or may vary.

Methods

This scoping review collated information from national policy reports, national guidance and case reviews as well as research evidence on:

• the conceptualisation of safety in different care settings
• the conceptualisation of safeguarding in different care settings
• governance approaches applied to safety, safeguarding (and risk) in different care settings.

Published and unpublished literature (1996-2014) was identified by conducting systematic searches of electronic databases, consulting publications from experts in the field and reference checking of identified sources. A range of databases was searched to ensure coverage from the fields of social, health, nursing and allied health care.

Additionally policy documents were scoped through a review of key policy documents, web-based searches to identify other relevant national and local policy, national and local guidance and case review material.

Findings

The findings suggest that health and social care may use and understand the terms safety and safeguarding differently: safeguarding in health appears to centre on abuse and neglect, while in social care the wider understanding of keeping people safe appears to be held. Despite the volume of health and social care literature that discusses safety, safeguarding and risk separately, there was little work that explicitly acknowledged the lack of congruence about how they were understood in different service contexts or that attempted to explore them in the context of integrated care.

In the light of the findings from this review, and as organisations and service provision become more integrated, it is essential that:

• clear and shared understandings of ‘safety’, ‘safeguarding’ and ‘risk’ are developed and that these definitions have resonance and can be owned by health and social care organisations and practitioners alike;
• more work is undertaken to understand the management and assessment of risk in the context of integrated service provision; shared and clear strategies are developed to help apply core principles for professional and organisational learning across different care environments; and
• the implications for a new agenda of personalisation of care in relation to risk and governance are explored.