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RELEVANT CHAPTERS

Preventing, Reducing or Delaying Needs

RELEVANT INFORMATION

Frailty in older people (Age UK)

Frailty and the NHS Long Term Plan (Age UK)

1. What is Frailty?

The term frailty or ‘being frail’ is often used to describe older people.

People who are frail often have reduced muscle strength and so get more tired easily (fatigue). They may find it much harder to recover from health issues such as a urinary tract infection or leg ulcers.

Frailty describes a person’s overall stamina and how this relates to their chance of recovering quickly from health problems. Approximately 10% of people aged over 65 are frail. In those aged 85 and over, this increases to 25-50% (Age UK).

People living with frailty may or may not have other major health conditions. Being frail can be seen as a fairly ‘minor’ health problem, but in reality it can have a severe and long term impact on a person’s physical and mental health and wellbeing.

2. Frailty and General Health

There are a number of health conditions that are associated with being  frail. Where staff from different organisations are working with a person, their carers and family, the overall aim should be that the person’s frailty does not result in poorer health outcomes for them (see Promoting Wellbeing and Preventing, Delaying or Reducing Needs chapters). It is important that a well-planned, joined-up care package is in place to prevent problems arising in the first place and provide a rapid, specialist response if their situation changes.

Where frailty is a concern, the following should be assessed and monitored on an ongoing basis as part of the person’s care and support plan (see Care and Support Planning chapter):

  • general health;
  • malnutrition and dehydration;
  • bladder and bowel problems;
  • dementia;
  • delirium (confusion);
  • mental health;
  • risk of falls.

2.1 General health

As people age their health needs change, but there are practical steps people can take at any age to improve their health and reduce their risk of frailty.

All aspects of a person’s health should be addressed as part of their general health needs. These include:

  • looking after their eyes;
  • looking after their mouth and teeth;
  • keeping active;
  • getting the right medicines;
  • getting vaccinations;
  • preventing falls;
  • looking after their hearing;
  • eating and drinking well;
  • looking after their bladder and bowels;
  • keeping mentally healthy;
  • keeping their brain active.

There are other issues that affect a person’s general health, including:

  • keeping warm;
  • making sure their home environment is safe;
  • preparing for winter as well as for heatwaves;
  • caring and looking after themself.

Information about all of these issues can be found in A Practical Guide to Healthy Ageing (NHS and Age UK). 

2.2 Malnutrition and dehydration

Having a balanced diet and sufficient (non-alcoholic) fluids are essential to keep well. This is particularly important for someone living with frailty.

Malnutrition affects approximately 1 in 10 older people and is a risk factor for becoming frail. It is a serious condition where a person’s diet does not have the right amount of nutrients. This could be due to not getting enough nutrients (undernutrition) or getting more than is needed (overnutrition). Both these factors can contribute to health conditions. Nutrients are important to maintain physical health and promote healing after injury or illness.

People who are malnourished are more likely to visit their GP, have hospital admissions and take longer to recover from illness or operations. If an older person loses weight, whilst it could be due to health conditions, it may also be a result of being malnourished.

Older people are also more at risk of dehydration, where the body loses more fluid than it is taking in. Symptoms of dehydration include:

  • feeling thirsty;
  • having dark yellow and strong-smelling urine;
  • feeling dizzy or lightheaded;
  • feeling tired;
  • having a dry mouth, lips and eyes;
  • not passing much urine – fewer than four times a day.

Dehydration is one of the most common reasons why an older person is admitted to hospital. It is also associated with increased risk of urinary tract infections, falls and pressure ulcers.

If it is suspected that a person who is frail is malnourished or dehydrated, with their permission (or their relevant person) their GP should be informed as soon as possible.

If the person is likely to become malnourished or dehydrated, ensuring sufficient intake of nutrition and fluids should be included in their care and support plan including working with the person to ensure they have food and drink that they like and can tolerate.

2.3 Falls

Falls can be common in older people and can result in serious health issues. Once someone has experienced a fall, particularly if it has resulted in a significant injury, it can be a main cause of loss of independence and even eventually going into long-term care. After a person has had a fall, the fear of falling again can result in a loss of confidence and self-esteem which can lead to them becoming increasingly inactive, this in turn leads to a loss of strength and a greater risk of further falls.

Working with someone to prevent them falling or from having further falls can include a number of simple practical measures such as:

  • making simple changes to their home;
  • ensuring they have the right medication;
  • ensuring they have the right prescription glasses; and
  • doing regular exercises to improve their strength and balance.

See Falls Prevention (NHS)

2.4 Bladder and bowel problems

Urinary and bowel incontinence and constipation are very common, particularly in older people. However, embarrassment and stigma about these issues mean people often delay seeking help and support. These conditions in older people are often poorly managed and can cause them a lot of distress. Not enough of an appropriate diet and fluids can also impact on a person’s bowel and urinary problems.

If there are concerns that a person who is frail is suffering incontinence or constipation, they – or their relevant person – should be supported to speak to their GP.

For further information about these issues, visit the websites below:

Urinary incontinence – NHS

Bowel incontinence – NHS

Constipation – NHS

2.5 Dementia

More than 850,000 people in the UK are estimated to be living with dementia. People who are living with frailty and who also have dementia are at increased risk of poor health as a result of not being able to care for themselves adequately, particularly if they are living alone.

For further information see Dementia: Practice Guidance chapter.

2.6 Delirium

Delirium is an episode of acute confusion. It can often be mistaken for dementia, but it is often preventable and treatable. Older people are more at risk of developing delirium and it can be quite common (particularly for those who have cognitive impairment, severe illness or have broken their hip or have a urinary tract infection for example).

Older people with delirium may have longer stays in hospital, have an increased risk of complications such as falls, accidents or pressure ulcers and be more likely to be admitted into long-term care. There is also a high mortality rate associated with delirium. It is therefore very important to recognise and treat delirium as early as possible, to avoid these complications.

For further information please see these websites:

Confusion (NHS) Sudden confusion (delirium)

Delirium – sudden confusion (Dementia UK)

2.7 Mental health problems

Mental health problems such as depression and anxiety can be quite common for older people, and can have a major impact on their quality of life. Mental health problems in older adults may not be reported and so often go undetected and are therefore under-treated.

Where an adult who is living with frailty is suspected of having mental ill health issues, they may be supported to speak to their GP or other relevant agencies.

See also Your mind matters (Age UK)

 3. Related Issues

3.1 Loneliness and social isolation

Many elderly people suffer from loneliness. This can have a serious effect on their mental and physical health and wellbeing.

Loneliness and social isolation can have additional negative impact on someone who is already living with frailty. There are different ways that loneliness can be addressed, depending on the needs, wishes and interests of the person. Discussions should take place with them to see what local services are available to support them to feel less lonely and isolated.

For further information see Elderly Loneliness (Age UK)

3.2 Physical activity

The benefits of physical activity for older adults is well evidenced, with multiple health benefits including promoting general health, improving cognitive function, lowering the risk of falls and reducing the likelihood of developing some long-term conditions and diseases.

Depending on the needs, wishes, interests and physical ability of the person living with frailty, there will be different options and organisations for them if they want to get involved in activities in their local area.

See also Being Active as you get Older (Age UK)

3.3 Safeguarding

People who are frail may experience, or be at risk of, abuse or neglect. This may be a result of their frailty or in combination with other mental or physical health conditions. They may be directly targeted by perpetrators who perceive them to be vulnerable or suffer unintentional abuse. Abuse may be committed by people they know such as family, friends or carers or by strangers.

People living with frailty may experience health and social care services that are not suited to their individual needs. They can also be vulnerable to receiving poor quality healthcare and services. In such circumstances they or their relevant person should be supported to make a complaint, as appropriate, to ensure that they receive the care and support to which they are entitled. This may need to involve the local authority and / or the Care Quality Commission if there are safeguarding concerns related to a service provider. For further information see Safeguarding Enquiries Process Section.

3.4 Supporting people at the end of life

Advanced care planning is key to ensuring a person who is frail receives good, personalised care at the end of their life. People should be encouraged to have proactive discussions about their wishes for care at the end of life as early as possible and their wishes recorded. These discussions should include advance decisions to refuse treatment and do not attempt resuscitation decisions.

See the chapter on Planning Ahead for Health and Social Care Decisions.

4. Living with Frailty

People living with frailty can be supported to live as full a life as they wish and are able, although this may mean they need to adapt how they live their life and find new ways to manage daily tasks and activities. This may apply to their family and friends too.

If someone is living with frailty, it does not mean they lack mental capacity (see Mental Capacity chapter) or cannot lead a full and independent life. Just because a person is frail does not mean that they cannot make decisions about their daily life or wider issues such as finances and where they live for example. They may need some practical support to put those decisions into practice however, where they may have physical difficulties for example in achieving those goals.

Frailty can deeply challenge a person’s sense of themself as well as change how they are perceived and treated by others, including health and care professionals. Ensuring they receive person centred care and their wishes and desires are listened to and acted upon wherever possible therefore, is key to their sense of self-esteem and ongoing enjoyment of life.

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Please note: If the issue concerns an NHS contracted service or care provision this will be dealt with by the defined NHS quality assurance process. Assurances and updates will be fed back into intelligence sharing meetings.

RELEVANT INFORMATION

Deciding if You need to Raise a Safeguarding Concern to the Local Authority (Flowchart)

Stage 1: Decision Making Process to Initiate the Managing Safeguarding Concerns at an Organisational Level Procedure

1.1 Collating inter-agency intelligence.

1.2 Multi-agency information and concerns raised via a number of methods and sources:

  • local authority led multi-agency intelligence meetings;
  • concerns raised from partner organisations;
  • consistent number of S42(1) related to the same service provider;
  • consistent Health Safeguarding Datix related to the same service provider;
  • quality of Consideration Logs.

Organisational concerns of a significant or critical nature should progress to a recommendation to DASS to invoke the Managing Safeguarding Concerns at an Organisational Level procedure.

1.3 When there is a body of information or sufficient risk to indicate proactive steps are required these will need to be considered against the Safeguarding Adults Thresholds Guidance Tool, notwithstanding any immediate risks being managed. A formal multi-agency meeting will be held to consider all information and intelligence to support the group in making a recommendation on action to take to the DASS.

This and subsequent meetings will be minuted to demonstrate the evidence and the level of concern to the DASS prior to initial decision making.

Note: Those that are of low concern will be dealt through other channels e.g. multi-agency intelligence meetings / agencies internal processes such as quality assurance / contract monitoring arrangements.

1.4 Recommendation made to Director of Adult Services (DASS)

1.5 DASS / Deputy to make decision and appoint a Lead Officer with immediate effect of agreeing the recommendation.

1.6 Role of Lead Officer: The Lead Officer will work with the Adult Safeguarding Coordinator to ensure a multi-agency Organisational Safeguarding Concerns Meeting is convened within appropriate timescales and involves all relevant agencies. The Lead Officer role includes ensuring timescales and targets are set, work is progressed according to plan, evidence is collated and there is effective document control.

The Lead Officer will be responsible for alerting the Organisational Safeguarding Enquiries Group, through the Chair, of any new risks / risks to achieving targets and plans and will take a key role in the Communication Strategy. In addition, where applicable, they may oversee the fact-finding process and / or organise people engagement to gain views and desired outcomes

1.7 Inform the organisation within one working day of the decision to enter the Managing Safeguarding Enquiries at an organisational level process. Any exceptional circumstances (for example police / coroner involvement etc) should be discussed with Lead Officer / DASS.

Stage 2: Initial Organisational Safeguarding Enquiries Fact Finding Meeting (Pre-meet) Organisation Joins Second Section

Look at Presenting Evidence / Immediate Risk Mitigation

2.1 Organisational Safeguarding Concerns Meeting organised within five working days of the DASS agreement to proceed. To include all relevant partners including the organisation to share information in order to assess risk / identify gaps in the information which is essential for providing assurance of the level of care and dignity provided:

First part of meeting to:

  • identify and clarify the totality of the level of concerns and any presenting risks from a multi partner perspective;
  • consider the scale and impact of any immediate risk management plans which have been implemented;
  • if appropriate, consider the organisations initial response;
  • if appropriate, consider latest CQC or quality monitoring reports.

Second part of the meeting to:

  • provide evidence and rational for the Safeguarding Enquiries on an organisational level process;
  • listen to the views of the organisation in question;
  • agree safeguarding planning; to consider and agree type of enquiries / leads /  timescales;
  • determine future risk management strategy and draw up quality assurance* and Communication Strategy** ;
  • consider protective actions for those currently in receipt of care and/or services from the organisation to be assured that acceptable levels of care / service are being received. If self-funding applies the locality in which organisation is based is responsible for offering reviews to those self-funding;
  • identify and agree on the quality assurance factors including how outcomes will be measured;
  • identify the outcomes of the process.

* Quality Assurance Strategy: It is important that the outcomes the person, families or friends want to see within the service provision are determined and every effort to achieve these outcomes; this may involve, for example, including changes suggested into the service improvement plan. For this reason, it is important a meeting is arranged early on in the process to identify these outcomes and quality assurance of evidence is benchmarked as to whether they meet this.

**Communication Strategy: outlines how, when and who information will be provided to and from to ensure all information is processed and acted upon to safeguard -people.

Stage 3: Findings Meeting

3.1 Findings Meeting organised no longer than 14 working days of the initial Managing Safeguarding Enquiries at an organisational level meeting. The purpose of the meeting is to:

  • assess and agree the findings from ‘fact finding’ enquiries;
  • draw up issues for a service improvement plan;
  • update the risk management plan and agree any further safeguarding measures;
  • consider actions to monitor the safety of people and agree triggers to escalate risk, whilst improvements are being made;
  • consider commissioning intentions;
  • preserve information that may be helpful to police investigations.

3.2 The organisation is expected to develop the Improvement Plan within 48 hours of this meeting.

3.3 The Improvement Plan should be shared with the Lead Officer and DASS and once finalised disseminated to applicable multi-agency partners by the Safeguarding Coordinator ahead of any future meetings.

Project Management Meetings

3.4 The Lead Officer will meet with the organisation throughout this stage of the process. The frequency of meetings should be agreed in advance and based on needs, but a general guide is weekly in the beginning to support the organisation with the embedding of change and to assure the immediate improvement of high-risk needs.

3.5 These meetings present an opportunity to review in depth the Organisation Improvement Plan, highlighting areas of high risk for focus. The Organisation Improvement Plan is key in this process, as it sets out clearly the expectation in respect to areas for improvement, timescales and the measurement of evidence required which will be quality assured.

3.6 Organisation Improvement Plans allow the Organisational Concerns Group and organisation to have oversight of the areas which are progressing and those still requiring completion.

3.7 The Organisational Concerns Meetings also provide an opportunity for the organisation to identify areas they feel improvements have been made or request for additional support. As an example, the Organisational Concerns Group may be able to assist with identifying trainers, examples of best practice recording tools or specialist services the organisation can link to for ongoing service support.

3.8 As change continues to be embedded, the frequency of the Organisational Concerns Group Meetings / Visits can be reduced.

3.9 The Lead Officer should provide feedback to the Chair on progress with the Organisational Improvement Plan, which will be shared with the Organisational Concerns Group via update meetings.

Stage 4: Update Meetings

4.1 Update Organisational Concerns Meetings will be held as and when required but are likely in response to areas of risk not being managed or corrected by the organisation. As risks are brought to the attention of the chair and the Organisational Concerns Group, update meetings are held in response to bring together senior level resources and expertise from across the partnership which can assist in resolving barriers.

4.2 Update Organisational Concerns Meetings will consider risk which will address the probability of risk and the likely impact of risk on the safety of people who use the services of the organisation. The meeting will consider if is it unsafe for people to continue to receive a service from the organisation; furthermore the meeting will also consider the risks of moving people to an alternative provision.

4.3 In cases where it has been assessed that the risk of continuing placements or allowing residents to stay in a placement are too high, consideration should be made as to suspension of placement and / or removal of residents.

Stage 5: Quality Assurance

5.1 Quality assurance of the improvements and their sustainability will be undertaken throughout the Managing Safeguarding Enquiries at an organisational level process. Feedback from people who have used a service and their carers will act as control measures to assess whether there has been noted difference in the organisations service delivery. An organisation will seek feedback from family and friends that the service has improved, these will be collated and included within the quality assurance strategy.

5.2 This process may be useful for planned quality assurance activities which are above and beyond those being undertaken throughout the process i.e. support from local Healthwatch or a degree of independent scrutiny as an activity.

Stage 6: Closing the Organisational Safeguarding Concerns Process

6.1 The final meeting considers the current level of risk, the sustainability of changes and feedback from people who use services and their relatives / friends.

6.2 Feedback obtained from the Quality Assurance Strategy will evidence whether the level of improvement and change that has taken place. These quality assurance activities may include, for example:

  • validation of organisation improvement plan by social care or health professional;
  • feedback from people who use services from the organisation, family and friends;
  • review by third party, such as partner Local Authority.

6.3 Upon an agreed from the Managing Safeguarding Enquiries at an Organisational Level Group decision that satisfactory improvements that are sustainable has been achieved, the Managing Safeguarding Enquiries at an Organisational Level Group responsibility will come to an end and the relevant parties, including the organisation, will be formally notified by the Chair within 24 hours of the meeting.

Organisation Learning

6.4 The Managing Safeguarding Enquiries at an Organisational Level Group may consider whether an organisational Learning Meeting is required. If this is agreed, the Lead Officer will convene a Learning Meeting, which the organisation will also be invited to.

6.5 The aim of the meeting is to establish what went well and what could be helpful to inform any future project and what might have been done differently.

6.6 Organisational learning identified through people who use services, families or their friends should be included, linking in to how outcomes they identified could be achieved and can be shared with other organisations to improve the prevention of abuse and quality of services.

6.7 Any lessons learnt can be fed into the safeguarding multi-agency training offer, commissioning cycle, improve the safeguarding adults’ function and raise awareness with other staff members. Any changes made to practice, improving the quality and safety for people who use organisations, can be disseminated within organisations bearing in mind the need for confidentiality.

Review

6.8 Contract monitoring review by the commissioning body is required in order to ensure that the improvements have been sustained. This should take place within three months of the initial submission of the Improvement Plan and be supported by evidence generated in the Project Management Meetings.

Appendices

1. Initial Organisation Concerns Meeting Agenda

Click here to view Initial Organisation Concerns Meeting Agenda

2. Initial Organisation Safeguarding Concerns Meeting Agenda with Guidance

Click here to view Initial Organisation Safeguarding Concerns Meeting Agenda with Guidance

3. Organisation Safeguarding Concerns Meeting Agenda

Click here to view Organisation Safeguarding Concerns Meeting Agenda

4. Managing Safeguarding Concerns at an Organisational Level Meeting Agenda with Guidance

Click here to view Managing Safeguarding Concerns at an Organisational Level Meeting Agenda with Guidance

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RELEVANT CHAPTER 

Working with Adults with Hidden Disabilities

RELEVANT INFORMATION 

Supporting Autistic People (Skills for Health)

National Autistic Society

Autism (NHS) 

Case Studies – Improving Support for People with a Learning Disability and Autistic People (Local Government Association)

The Oliver McGowan Mandatory Training on Learning Disability and Autism (NHS England)

May 2023 – This chapter has been reviewed and updated to include information on the Oliver McGowan Mandatory Training on Learning Disability and Autism.

 1. Introduction

Autistic adults may have been diagnosed as a child, or when they are older. Some may not have been diagnosed at all; this may be because they do not realise they are autistic, have not have wanted support or have not felt able to speak to anyone about it.

Many people learn to cope with autism in their own way, although this may not be easy. They may be married or living with a partner, have families and successful careers. Others may be socially isolated, especially if they find it difficult to spend time with family or make friends.

This chapter is a summary of some of the main issues that staff need to consider when working with an autistic adult, to help ensure their needs and wishes are identified and taken into account and adjustments are made as required so they can participate fully in decision making. It also provides additional references and website links.

2. What is Autism?

Autism affects how people communicate and interact with the world.

The cause of autism is unknown, or if in fact if there is a definite cause. More than one in 100 people are autistic, and there are around 700,000 autistic adults and children in the UK (National Autistic Society). Whilst people from all nationalities, cultural, religious and social groups and be autistic, more males are diagnosed than females, but this may be a result of under-diagnosis in females.

Autism is not an illness or disease; it cannot be ‘cured’. It is a lifelong condition, and some people feel that being autistic is an important part of their identity. Autism  may not be visible and therefore can be easily missed  (see Working with Adults with Hidden Disabilities chapter).

All autistic people can learn and develop. Getting the right support and understanding makes a huge difference to autistic people.

3. The Autism Spectrum

See also What is Autism? (National Autistic Society)

Autism is a spectrum condition; there is a wide variation in the type and severity of symptoms that people can experience. All autistic people share are affected in different ways.

Autistic people may:

  • find it hard to communicate and interact with other people;
  • find it hard to understand how other people think or feel, and find it how to say how they feel themselves;
  • find it hard to make friends or prefer to be on their own;
  • seem blunt, rude or not interested in others without meaning to;
  • be highly focused on interests or hobbies;
  • be over or under sensitive to smells, light, sound, taste, textures or touch, finding them stressful or uncomfortable;
  • get very anxious or upset which can lead to meltdowns or shutdowns;
  • take longer to understand information;
  • do or think the same things over and over and feel very anxious if their routine changes, resulting in repetitive and restrictive behaviour.

Autism is not a learning disability, and autistic people can have any level of intelligence. However, autistic people may have other conditions (see Section 4, Related Conditions), which will mean they need different levels of support.

4. Related Conditions

Other conditions that can also affect autistic adults include:

  • Attention deficit hyperactivity disorder (ADHD);
  • dyslexia and dyspraxia;
  • problems sleeping (insomnia);
  • mental health problems;
  • learning disabilities;
  • epilepsy;
  • problems with joints and other parts of the body, including:
  • flexible or painful joints;
  • skin that stretches or bruises easily;
  • diarrhoea or constipation.

For more information on these conditions see Other Conditions that affect Autistic People (NHS)

5. Assessment and Diagnosis

If a person thinks they may be autistic and wants to speak to someone about it, they should make an appointment to see their GP. If you think an adult you are supporting may be autistic, the National Autistic Society has advice on how to discuss this with them (see Broaching the Subject).

They may be referred to a specialist for an autism assessment (see What happens during an Autism Assessment, NHS).

An autism diagnosis can be a daunting time, and may come as a shock, but for others it is a relief to find out why they think, feel and act the way they do.

Autism is not a medical condition that can be treated or cured, but following assessment, autistic people can benefit can access appropriate support and interventions, and adjustments can be made to help them stay well and have a good quality of life.

See also Newly Diagnosed: Things to Help (NHS)

Assessments and care and support plans should be reviewed and revised if it is felt that a person’s condition, or related conditions, are either deteriorating or improving. In addition, under the Equality Act 2010, services should make changes to the way they are delivered to ensure they are accessible to autistic people and people with other disabilities. The changes are called ‘reasonable adjustments’. Autistic people should always be asked if they require reasonable adjustments, and details of these should be clearly recorded and referred to each time the person accesses the service. Reasonable adjustments should be reviewed to ensure they continue to reflect a person’s circumstances.

6. Working with Autistic Adults

Autistic people can live a full life; it does not have to stop anyone having a good life. Like everyone else, autistic people have some things they are good at as well as things they find more of a challenge. A strengths-based assessment (see Section 5, Assessment and Diagnosis) should reveal these and be included in the person’s care and support plan, alongside any ‘reasonable adjustments’ to the way services will be delivered.

Everyone is different, but there are some common characteristics that staff should consider when communicating and working with an autistic person. It is important avoid making assumptions about an autistic person’s experiences or needs, every autistic person is unique and will have a specific set of strengths and needs.  Ask the person what you can do to make the process easier for them and listen to and implement their suggestions where possible.

  • Personalisation: Make sure the person is at the heat of all decision making, work with them to identify their unique abilities and challenges, and then work alongside them to achieve their (self) identified needs;
  • Communication: Staff should remember that the person may find it difficult to communicate and interact with other people. Staff should understand that what the person says and how they say it may well be a feature of their condition. They should give the person time to communicate and be calm and considered in their communication with them. Ask about their communication needs / preferences.
  • Understanding: The adult may find it difficult to understand how other people think or feel, therefore staff should remember that they may not be deliberately unfeeling or uncaring, but they are not able consider other people in the way that others do.
  • Suitable environment: Staff should ensure that any meeting or intervention with an autistic person does not take place in a noisy or over-stimulating environment. If they meet the person outside the workplace, they should find out from them what type of place they like to go, that is manageable for them and does not cause them additional stress.
  • Anxiety: Autistic people can get anxious or stressed about unfamiliar situations and social events. Staff should take this into consideration when working with someone and plan interventions or meetings accordingly.
  • Presenting information:  Autistic people may take longer to understand information that is presented to them. Staff should give them additional time to process information and provide it in easy read formats or give other assistance where required. They should also check with the person that they have understood what is being communicated, both at the time and also check their understanding again at later dates.
  • Take time: Autistic people may do or think the same things over and over again. Staff should bear this in mind when working with autistic people, and build additional time into their meetings and visits so that the person does not feel pressured to be quicker than is comfortable for them. Attempts to rush them may result in them feeling stressed which in turn may negatively impact on other behaviours. Multiple visits may be required.
  • Training: Training is important, as it helps to ensure that staff have the right skills and knowledge to be able to provide safe, compassionate, and informed care to autistic people. Under the Health and Care Act 2022 there is a requirement for regulated service providers to ensure that their staff receive training on learning disability and autism which is appropriate to their role. The Oliver McGowan mandatory training on learning disability and autism is the government’s preferred and recommended training for staff to undertake. The training is delivered in two parts: Tier 1 is for people who require general awareness of the support autistic people and people with a learning disability may need, and Tier 2 is for people who provide care and support to autistic people or people with a learning disability. Both tiers begin with an e-learning session. Employers are responsible for ensuring their staff have the appropriate training for their role, and will advise staff on whether they should complete Tier 1 or Tier 2.

7. Further Information

7.1 National organisations and sources

National organisations that provide detailed or further information include:

There are a number of social media pages about issues affecting autistic people. These include:

Facebook:

X (formerly Twitter):

Forums and communities:

7.2 Local support

Autism Hub (South Tyneside)

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RELEVANT INFORMATION

The Care Act and Whole-Family Approaches (Local Government Association et al) 

RELEVANT CHAPTER

Domestic Abuse

1. Introduction

It is essential that workers in adult social care and partner agencies who are working with adults with care and support needs, consider and include the needs of all family members when carrying out assessments and developing plans.

There are four steps to the Whole-Family Approach:

  • Step one: Think family;
  • Step two: Get the whole picture;
  • Step three: Make a plan that works for everyone;
  • Step four: Check it is working for the whole family.

This chapter is taken from The Care Act and Whole-Family Approaches (Local Government Association et al) and provides guidance about using the Whole-Family Approach in daily practice. Whilst it is written for local authority workers, it is appropriate to everyone working with an adult receiving care and support services and their families.

2. Step 1: Think Family – Early Intervention and Prevention

Under the Care Act 2014, a whole council, whole-family approach which organises services and support around the adult and their family must be taken. It also means that everyone working with the adult and their family must think about the needs of each member of the family, including any children.

The principle of wellbeing is at the heart of this approach (see Promoting Wellbeing chapter). A vital part of an adult’s wellbeing is the situation they live in, who they live with and their family relationships. It is important to achieve a balance between their wellbeing and that of any family or friends caring for them.

A whole-family approach to promoting wellbeing and preventing need for care and support may include helping the adult and their family to think about what changes may happen in the future, and to plan for these, for example when the adult needs more care or if a carer becomes unwell for example (see Reducing, Preventing or Delaying Needs chapter).

The needs of young carers, for example a teenager who has to look after their disabled mother, are included in both the Care Act 2014 and in the Children and Families Act 2014. This is to make sure all workers involved take a whole-family approach to assessing and supporting the adult and the young carer and delivers support in a coordinated, organised way. See Annex A of The Care Act and Whole-Family Approaches (Local Government Association et al).

In an organisation that thinks family:

  • There should be senior leadership commitment to a whole-family approach with protocols in place so that services can be coordinated.
  • Staff training ensures the skills and referral arrangements are in place so that service protocols are operating ‘on the ground’.
  • Family-related questions are embedded in processes at first contact and subsequently, such as:
    • Who else lives in your house?
    • Who helps with your support and who else is important in your life?
    • Is there anyone that you provide support or care for?
    • Is there a child in the family (including stepchildren, children of partners or extended family)
    • Does any parent need support in their parenting role?
  • There is an active approach to establishing if there are any significant potential changes in families’ lives and working with them to plan for these.
  • Families and carers are an integral part of the design, delivery and evaluation of services and support. (Adapted from the LGA guidance, p. 3)

3. Step Two: Get the Whole Picture – Whole Family Assessment

Getting the whole picture means seeing each person as an individual, as well as recognising the part they play in their family and community. Everyone has something to contribute to addressing the adult’s needs. The Whole-Family Approach builds on everyone’s strengths and develops their resilience. It also promotes working together with carers as partners, as well as the adult and other members of the family and friends where appropriate.

Understanding the needs of the whole family and getting them to think about the outcomes they want to achieve individually, as well as a family is vital. It means the worker can then provide the right guidance, information and services.

Assessment is an important part of the process for everyone. During the assessment, the worker can give guidance and information to help the family understand the situation, their needs and strengths. This can help to reduce or delay any increase in the adult’s needs and make sure that they have support when they need it. The aim of assessment is to get a full picture of the person and their needs and goals, so any carers must be consulted. Carers are recognised in the Care Act, in the same way as those they care for.

In an organisation that gets the whole picture:

  • Information on the assessments and care plans that family members are receiving from other organisations is routinely identified and shared between partner agencies as appropriate. Where possible and appropriate, assessments are coordinated or combined.
  • Proportionate assessments are undertaken in a way that is most appropriate to each family.
  • People providing care and support are identified and involved in assessments to provide their expertise and knowledge and views of what works and what does not.
  • Risks to carers of sustaining their caring role are always considered.
  • Carers’ willingness to continue caring is always established.
  • Where they wish to have one, carers are provided with an assessment carried out by their local council. In such circumstances, the council will consider the carers’ eligibility for support in their own right.
  • In all instances, even when a person can achieve an outcome independently, consideration is given to any impact on others and whether they might be adversely impacting on the health or safety of others, particularly family members and children.
  • At assessment, all of a person’s needs are identified regardless of whether they are being met by any carer.
  • Consideration of the ability to maintain family or other significant relationships, including with any children, and the impact on the adult’s wellbeing of these not being maintained is always considered. This applies to both the person in need of care and support and their carer.
  • When a child may be a young carer, consideration is always given as to whether to undertake a young carer’s needs assessment under section 17 of the Children Act 1989.
  • Assessments of an adult identify any potential child in need who does not have any caring responsibilities. (Adapted from the LGA guidance p. 4)

Where an assessment does identify a potential child in need, the worker should contact their line manager to discuss the situation and a referral should be made to children’s services as appropriate (see South Tyneside Safeguarding Children procedures).

4. Step Three: Make a Plan that Works for Everyone – Developing Plans

When councils and other agencies adopt a whole-family approach to developing care and support plans, this can help to achieve the best outcomes for the whole family. Sometimes, however, a plan can have a negative impact on other members of the family, particularly carers. This is something which must be considered when plans are reviewed.

A whole family approach can also make better use of resources. Sometimes plans are needed for more than one member of the family and from different organisations, for example the Care Programme Approach if mental health services are involved. Plans should not be developed in isolation from one another but should be developed together. If everyone involved agrees, including the practitioners, plans for different family members can be combined to form a single plan in which there may be parts for individual family members as well as the family as a whole. This can be particularly important in making sure that everyone’s wellbeing is being considered and it can also be helpful in addressing any areas of conflict that arise and agreeing a way forward so that everyone achieves what they need, as far as possible.

In an organisation that makes plans that work for everyone:

  • Planning takes into account the wellbeing of all the family and the impact of any services and support on other family members. This includes identifying and responding to situations such as mutual caring, and carers living at a distance or outside of the local area.
  • Planning always involves carers, and consideration is given to the involvement of other family members.
  • Planning considers how carers can be supported to look after their own health and have a life alongside caring.
  • Plans include consideration of support to ensure a carer is able to fulfil any parenting role.
  • Consideration is given to how a person’s circle of support can be developed, where this might benefit them.
  • Plans from different organisations for any family members are identified and consideration given as to whether these can be aligned, coordinated or integrated into a single plan (where all involved agree).
  • Where plans are integrated, a lead organisation is identified to undertake monitoring and assurance. It must be clear when the plan will be reviewed and by whom. (Adapted from the LGA guidance p. 5)

5. Step Four: Check it is Working for the Whole Family – Review of Plans

As with assessment and care planning, wherever possible a whole-family approach to reviews should be taken. It should concentrate on the results that are being achieved by the adult and their family. Workers should consider giving others permission to conduct the review; this could be the person themselves, a carer or someone else.

Workers need to oversee the process and sign off all reviews. Sometimes a ‘light touch’ approach can be helpful in the early stages, which might include a telephone call or asking the adult or another family member to carry out a self-review to check that things are working as intended. Whatever approach is used, it should always include consider any impact of the plan on other family members.

Where the review identifies things that have changed, the plan may need to be updated to include these. Again the adult, their carer and anyone else they want included should be involved. The whole-family approach should make sure that everyone’s needs and wellbeing are considered (including any children), that there are no consequences for anyone that had not been seen in advance and that everyone agrees with the plan.

In an organisation that knows its approach is working for the whole family:

  • The impact of the plan and results being achieved are reviewed in relation to both the individual and the whole family. This includes consideration of any unintended consequences for other members of the family.
  • Consideration is given to any changes that can be made to maximise the benefit to the whole family.
  • Carers’ (including young carers’) needs are routinely reviewed and the support they are willing and able to provide, as well as the outcomes they want to achieve, is re-established.
  • Any anticipated changes in the family that may impact on needs and support are identified and considered in any revised plan.
  • The plan is checked to see that it is providing adequate support to ensure children are not expected to offer inappropriate or excessive levels of care. (Adapted from the LGA guidance p. 6)

6. Tools to use with the Whole-Family Approach

Annex C of The Care Act and Whole-Family Approaches (Local Government Association et al) 

includes some practical tools for working with families which can be adapted and developed for local use. These include:

  • questions to consider including in conversations at initial contact, assessment and care planning stages;
  • whole-family care planning discussion questions;
  • a genogram
  • how to identify support networks;
  • an emergency crisis plan.

Annex D also provides a checklist of key practice points.

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RELEVANT INFORMATION

Northumbria Missing Adults Protocol– Guidance for police and partner agency staff about the joint response to adults at risk of or who have gone missing.

Hospitals Missing Adult Patient Protocol – Outlines the role of Northumbria Police in assisting NHS Trusts to locate and ensure the wellbeing of patients who have been declared missing and there is a genuine concern for their safety.

Herbert Protocol – A national scheme introduced by the police in partnership with other agencies which encourages carers and family members to record useful information, which could be used in the event of a vulnerable person with Alzheimer’s or dementia going missing.

Philomena Protocol – An initiative that helps locate and safely return a young person who is a looked after child (in care) as quickly as possible when they are missing (see also Transition to Adult Care and Support chapter).

Winnie Protocol – A Northumbria Police and Northumberland, Tyne and Wear Safeguarding Adult Boards scheme to encourage carers and professionals to record useful information which could be used in the event of an adult going missing. It is differs from the Herbert Protocol as this can be completed for any adult who goes missing.

Northumbria Police Hostel Policy – This policy explains the process Northumbria Police will use to assess the most appropriate course of action when a person is reported missing from a hostel.  It explains the 8 criteria which will be used to determine whether or not the incident should be closed.

See also Missing Persons, Northumbria Police

November 2023: A link to the updated Northumbria Missing Adults Protocol was added.

 

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SOUTH TYNESIDE SPECIFIC INFORMATION

Safeguarding: Keeping you Safe from Abuse and Neglect (Easy Read Leaflet)

RELEVANT CHAPTERS

Equality, Diversity and Human Rights in a Safeguarding Context

Mental Capacity

RELEVANT INFORMATION

Councils need to check how they help People with Hidden Disabilities (Local Government and Social Care Ombudsman)

September 2022: Section 2.2, Developmental / neurodevelopmental disabilities and Section 7, Training and Awareness have been revised. Section 6, Hidden Disabilities Sunflower Lanyard is new.

1. Introduction

Not all disabilities can be seen from a person’s outward appearance. Hidden disabilities are sometimes also called invisible disabilities and include, for example, mental and physical health problems and developmental disabilities.

Following an investigation of three complaints against London Councils, the Local Government and Social Care Ombudsman recommended that local authorities should check their procedures to avoid disadvantaging people with hidden disabilities.  This advice also applies to all organisations working with adults with care and support needs.

In each of the cases investigated by Ombudsman, the found that the local authorities did not do enough to help people with hidden disabilities to use their services. This included not making reasonable adjustments to help a woman with autism to repay overpaid housing benefit, and not helping a man with severe dyslexia to deal with parking tickets and permits.

2. Types of Hidden Disability

Whilst there is now a better understanding of some of the conditions that constitute hidden disabilities, it is vital that all interactions with adults, including assessments, are conducted with hidden disabilities in mind. This is to ensure all relevant care and support issues affecting the adult are identified, to ensure they receive the appropriate services relevant to their individual needs. This process is vital to ensure that people with hidden disabilities are not discriminated against, as a result of their disability being missed or reasonable adjustments not being made.

The lists below are not exhaustive; there will be other physical and mental health problems and other conditions that result in hidden disabilities.

2.1 Mental health

For many adults who suffer with mental health problems, their issues may not be immediately obvious and can be misunderstood. Without good working relationships and without a member of staff undertaking a comprehensive assessment with the adult, key aspects of the care and support that they require may be missed and their problems, therefore, could be compounded. Such issues may include depression, stress, bipolar disorder, psychotic and neurotic thought processes and suicidal thoughts.

2.2 Developmental / neurodevelopmental disabilities

Other conditions which can be hidden include:

  • Dyslexia (development of literacy and language related skills affected);
  • Dyspraxia (perception, language and thought processes affected);
  • Attention Deficit Hyperactivity Disorder – ADHD (inattentiveness and hyperactivity-impulsivity);
  • autistic spectrum disorder  / ASD (communication, interaction and relationships with others can be affected).

Adults with such conditions often develop ways of coping which may make it difficult for staff to identify them as disabled. Even when someone can function well in many situations, this does not mean they are not disabled.

Issues to be aware of include:

  • communication issues (verbal and non-verbal);
  • understanding instructions;
  • the speed at which they process things; and
  • interpretation of social situations.

Some of these conditions may also co-exist with other hidden disabilities.

See Autism UK: What is Autism and Related Conditions for more information.

The Autism Act 2009 came into force in January 2010. Under the Act the Government has to publish and keep under review an Autism Strategy, as well as guidance for implementing the strategy which requires local authorities and NHS bodies to act (see Adult Autism Strategy: Supporting its Use; Department of Health and Social Care) and National Strategy for Autistic Children, Young People and Adults: 2021 to 2026 (Department of Health and Social Care and Department for Education).

2.3 Physical health issues

Not all physical health problems are clearly visible. There are many conditions which can be hidden to include hearing and sight impairments, chronic fatigue syndrome / myalgic encephalomyelitis (ME), chronic pain and chronic illnesses such as fibromyalgia, epilepsy, diabetes, kidney failure and sleep disorders.

Such conditions should also be taken into consideration as a hidden disability.

2.4 Other issues for consideration

2.4.1 Mental capacity

See also Mental Capacity chapter

Adult social care staff and other staff working with adults should be particularly mindful in considering mental capacity issues for adults with hidden disabilities when:

  • assessing needs and make care planning decisions;
  • conducting safeguarding enquiries;
  • when there is a dispute over ordinary residence.

2.4.2 Human rights

See also Equality, Diversity and Human Rights in a Safeguarding Context chapter

Article 3 of the Human Rights Act 1998 imposes a duty to take reasonable steps to provide effective protection to children and other vulnerable persons whom the state knows or ought reasonably to know, are being subject to inhuman or degrading treatment (see also Z v United Kingdom Application No 29392/95, (2001) CCLR 310, ECHR).

3. Equality Act 2010

See also Equality, Diversity and Human Rights in a Safeguarding Context chapter

It is essential that people with hidden disabilities are not either directly or indirectly discriminated against, that is they should have the same level of assessment, care and support planning, care and support services and other opportunities as those who do not have a disability.

“The Equality Act 2010 requires councils to anticipate the needs of people who may need to access their services. This means when councils are alerted to the fact someone might need to be treated in a different way, they should ask that person what adjustments are needed, and consider whether these are reasonable…. We recognise the significant challenges faced by public service providers in adapting their processes to the needs of people who may require adjustments, particularly where the services have been automated. But this is a duty councils must meet and needs they must anticipate.” Local Government and Social Care Ombudsman

4. Working with Adults who may have Hidden Disabilities

Staff working with adults should be aware that they, or their carer, may have hidden disabilities, particularly those who are having contact with the service for the first time. It is important to not make quick judgments about a person based on initial communication.

Where there are communication issues or other factors are present that are not otherwise easily explained, staff should consider whether hidden disability / disabilities may be the cause and carry out further investigations as appropriate.

When a hidden disability is discussed with an adult and / or their carer, the member of staff should record both the discussion and the hidden disability in the adult’s case records (see Case Recording chapter). Where the adult already has a care and support plan, this may mean a review is required and adjustments to the plan may be required to respond to the newly disclosed / diagnosed disability which may change the person’s eligible care needs within the care and support plan.

5. Blue Badge Scheme

The Blue Badge scheme has been extended to include people with hidden disabilities, such as autism and mental health conditions, for example.

The criteria have been extended so that people are eligible who:

  • cannot undertake a journey without there being a risk of serious harm to their health or safety or that of any other person;
  • cannot undertake a journey without it causing them very considerable psychological distress;
  • have very considerable difficulty when walking (both the physical act and experience of walking).

This is particularly important for adults who find leaving their house a challenge. This may involve detailed preparations and sometimes overwhelming anxiety about plans going wrong or not being able to find parking spaces. Some autistic people might be unaware of road safety issues or become overwhelmed by busy or loud environments.

For further information see: Running a Blue Badge parking scheme: Guidance for local authorities (UK Government)  and Blue Badge Scheme (South Tyneside Council)

6. Hidden Disabilities Sunflower Lanyard

This is a symbol a person can wear if they have a hidden disability, or on behalf of somebody that does. For example, parents or carers may choose to wear lanyards for the people they support.

A lanyard helps to inform others, health professionals and members of staff in public places, that the person wearing it or someone with them has a hidden disability – this includes autism, chronic pain, dementia, hearing impairment.

Hidden disabilities that are eligible for sunflower lanyard include:

  • a learning disability;
  • sensory loss, including difficulty seeing or hearing;
  • dementia including Alzheimer’s disease;
  • autism;
  • anxiety or any other mental health condition;
  • a physical disability that may not be obvious.

See The Hidden Disabilities Sunflower Lanyard scheme.

7. Training and Awareness

Local authorities and other service providers should ensure they have a disability policy, ensure that staff are aware of hidden disabilities and know how to respond appropriately.  It should be addressed as part of general equal opportunities training.

Other associated training to consider include:

  • autism awareness;
  • disability awareness;
  • mental health awareness.

See NHS Learning Disability Employment Programme.

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RELEVANT CHAPTERS

Managing Risk

RELEVANT INFORMATION

Work Related Violence (Health and Safety Executive) 

This chapter was added to the APPP in January 2020.

1. Introduction

Harassment and violence towards staff can have a direct effect on their health and safety. It can also affect standards of work, performance, confidence, morale of all staff.

Staff in roles most at risk are those who:

  • give a service;
  • are carers;
  • in education;
  • involved in cash transactions;
  • make deliveries / collections;
  • exhibit controlling behaviour towards others;
  • represent authority.

Those committing acts of harassment and / or violence to staff maybe adults with care and support needs, their family or friends or other members of the public. A person who commits such acts may be subject to a police investigation and criminal prosecution or other organisational sanctions, such as loss of service.

Managers and staff have a responsibility to abide by the policies and procedures of the service to:

  • limit incidents of harassment and violence;
  • respond to them appropriately;
  • protect themselves and their colleagues;
  • reporting the incident to the police with a view to prosecution where appropriate.

2. What is Violence and Harassment?

2.1 Violence

Violence to staff is defined abuse, threats or assaults in circumstances relating to their work. This includes:

  • verbal abuse;
  • offensive language;
  • discriminatory or derogatory remarks, for example those which are racist, sexist or homophobic in nature;
  • obscene gestures;
  • threatening behaviour;
  • stalking;
  • physical attacks;
  • spitting; and
  • throwing objects.

2.2 Harassment

Harassment is when a person causes alarm or distress to a member of staff; this can result in the victim being put in fear of violence. It can include repeated attempts to communicate with the member of staff, which are clearly unwanted and contact them in a way that the perpetrator expects to cause them distress or fear.

3. Assessing Risk from Violence and Aggression

The main factors that can create risk are:

  • mental health disorders;
  • impatience;
  • frustration;
  • anxiety;
  • resentment;
  • drink and / or drugs;
  • inherent aggression.

3.1 Violence risk assessments: staff responsibilities

Every adult who has a history of aggression / violence must have a care and support plan risk assessment. This should identify the risks and states the actions to be taken to minimise these risks. This should include family or friends who have such a known history, even if the adult themselves does not present a risk.

Information should be shared with other concerned organisations.

Systems in place to flag high risk cases should be activated.

Risk assessments should be regularly reviewed, care plans updated and actions taken to minimise risks.

Senior managers should be informed of risks and decisions documented and signed on case files.

3.2 Violence risk assessments: managers responsibilities

When carrying out a potential violence risk assessment, the following factors should be considered.

In the workplace:

  • work activities;
  • working conditions;
  • design of the work activities and surrounding environment;
  • frequency of situations that present a risk of workplace violence;
  • severity of the potential consequences to the member of staff who may be exposed to a risk;
  • information on workplace violence based on historical evidence and accurate information;
  • measures already in place to prevent workplace violence.

The wider working environment:

  • description of the department or area the manager or supervisor is in charge of;
  • history of violence in the department / service area;
  • activities in the department / service area that could expose workers to violence;
  • circumstances that might increase the risk of violence in the department / service area;
  • measures in place to address violence and the resources needed to implement them.

3.3 Recording

See Case Recording chapter

It is crucial for the safety and wellbeing of staff, adults and the protection of the organisation and wider community that risk assessments are fully documented. This includes clearly documented management oversight and decision making.

4. Management Responsibilities

Managers must assess the risk of both physical and non-physical assault to staff and take appropriate action to deal with it.

These steps may include:

  • providing suitable training and information;
  • improving the design of the working environment (such as physical security measures);
  • making changes to aspects of staff roles;
  • following the escalation policy of the organisation including reporting high risk cases of potential risk of violence and all incidents of actual physical and non-physical assault so that preventative action can be taken to ensure it is not repeated.

This will also help managers to check for patterns and so help predict the types of incidents that could occur.

Findings from all risk assessments should be communicated to all staff as appropriate, and arrangements need to be put in place to monitor and review such assessments.

Mechanisms should be in place to share learning with staff and across the service.

4.1 Staff support

Depending on the seriousness of the incident, staff who have been the victim of harassment and / or violence should receive robust support from managers and the organisation’s human resources department as appropriate.

This may include:

  • debriefing by the line manager, as soon as possible following the incident;
  • supervision with the line manager for a more indepth examination of the incident and any learning points that arise or further discussion with other colleagues including senior managers;
  • team discussion regarding the incident where appropriate to share learning and any change in practice required;
  • referral for counselling for the member of staff, where required;
  • support for the member of staff and the line manager, as required, in the case of any ongoing police investigation and subsequent prosecution or other internal organisational sanctions taken against the person perpetrating the harassment or violence.

Managers should also ensure that where the perpetrator is an adult who still uses the service, that steps are taken to discuss the situation with them, their behaviour, how they could have responded differently and referral to other agencies for support / interventions regarding behaviour management as appropriate.

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SOUTH TYNESIDE SPECIFIC INFORMATION

South Tyneside Housing Strategies 

RELEVANT INFORMATION

Integrated Health and Social Care for People Experiencing Homelessness (NICE)

Housing LIN (Learning and Improvement Network)

Homelessness: duty to refer – for NHS staff (Department of Health and Social Care)

Capacity and Housing Issues (39 Essex Chambers)

September 2022: This chapter has been updated to include reference to a new category of primary need which was introduced in the Domestic Abuse Act 2021.

1. Introduction

The relationship between local housing and adult and social care departments can be complex because there are often legal and practical difficulties arising from circumstances where vulnerable adults and families fall below or between two legal frameworks. Their needs may not be sufficient to qualify them under the Care Act 2014 (CA) but they may also not meet the criteria for a positive housing decision because they do not have sufficient vulnerability to be assessed as being in ‘priority need’ (see Section 4.2.2, Section 189: Priority Need).

The CA allows the local authority to provide any type of accommodation which may be called ‘ordinary accommodation’, that is “accommodation in a care home or in premises of another type” where they would receive care and support services relevant for their assessed needs.

From an adult social care perspective, the local authority must not meet a person’s care and support needs by taking any action which is required – either by itself or another local authority – under the Housing Act 1996 (HA) or other housing related legislation. A local authority can provide ordinary accommodation under the CA when they are not under a duty to provide that person with accommodation under the HA.

Once the local authority has assessed an applicant’s needs as satisfying the relevant criteria, it must provide accommodation on a continuing basis so long as the need of the applicant remains as the same as originally assessed.

A local authority from an adult social care perspective may provide ordinary accommodation, and any other service within reason, to an adult whom it assesses as needing care and support under the CA; whether or not the local authority uses that power is for it to decide.

See also Appendix 1: Further Information.

2. South Tyneside Homelessness Service

Click on the link to view Homelessness: South Tyneside Homes

3. Safeguarding Concerns

Adults who are homeless may be vulnerable to abuse, whether they are rough sleeping, sofa surfing or in temporary accommodation. For example their lack of stable accommodation can leave them vulnerable to physical, emotional or sexual abuse, criminal exploitation and their possessions vulnerable to theft.

Staff who work with adults who are homeless should be aware of the increased possibility of safeguarding issues, be able to recognise the signs of potential abuse and to take action if they suspect that someone is being abused (see Stage 1: Concerns chapter).

4. Homelessness Legislation

4.1 Housing Act 1996

The main legislation that addresses local authority duties in relation to people who are homeless is the Housing Act 1996. This states the legal requirements that underpin local authority action to prevent homelessness and provide assistance to people who are threatened with homelessness or who are homeless.

In 2002, the legislation was amended through:

  • the Homelessness Act 2002 which means each local housing authority has a duty to undertake a review of homelessness and to develop and implement an effective strategy to deal with homelessness in consultation with both Social Services and other organisations; and
  • the Homelessness (Priority Need for Accommodation) (England) Order 2002 which extended the class of persons with a priority need for accommodation to six additional categories:
  • 16-17 years old;
  • 18-20 care leavers ;
  • vulnerable care leavers;
  • former members of the armed forces;
  • vulnerable former prisoners;
  • persons fleeing violence.

These were introduced to ensure a more strategic approach to tackling and preventing homelessness and to strengthen the assistance available to people who are homeless or threatened with homelessness by extending the priority need categories.

The Domestic Abuse Act 2021 further added to the categories of priority need by extending these to include people who are made homeless as a result of domestic abuse.

4.2 Homelessness Reduction Act 2017

The Homelessness Reduction Act 2017 (HRA) amended the Housing Act 1996.

One of the aims of the HRA is to ensure that all eligible households who are homeless or threatened with homelessness receive genuine and effective advice and assistance to help them secure accommodation. The HRA aims to widen access to homelessness advice and prevention services for all households who are experiencing homelessness or who are at risk of losing their home. It introduced a statutory duty to carry out assessments on all applicants, as well as duties to prevent and relieve homelessness in all cases.

Key sections in the Act are outlined below.

4.2.1 Section 179: Expanded the general duty to provide advice

Local housing authorities have a duty to ensure that advice and information on homelessness prevention and on how people can access help and support when homeless is made available free of charge. The HRA specifies the types of information that have to be made available and requires that advice and information be tailored to meet the needs of the following specific groups:

  1. people released from prison or youth detention accommodation;
  2. care leavers;
  3. former members of the regular armed forces;
  4. victims of domestic abuse;
  5. people leaving hospital;
  6. people living with a mental illness or impairment; and,
  7. any other group that the authority identify as being at particular risk of homelessness in their area.

The local authority can provide this advice themselves or arrange for other agencies to do it on their behalf.

4.2.2 Section 189: Priority Need

A person who is homeless and who approaches the local authority for assistance (known as an eligible applicant) has to fall into one of the priority need categories in order for the local authority to have a duty to obtain temporary accommodation for them. The following people have a priority need for accommodation:

  1. a pregnant woman or a person with whom she resides or might reasonably be expected to reside;
  2. a person with whom dependent children reside or might reasonably be expected to reside;
  3. a person who is homeless or threatened with homelessness as a result of an emergency such as flood, fire or other disaster;
  4. homeless 16 and 17 year olds;
  5. care leavers aged 18, 19 and 20;
  6. a person who is vulnerable as a result of old age, mental illness or handicap or physical disability or other special reason, or with whom such a person resides or might reasonably be expected to reside;
  7. people who are vulnerable as a result of time spent in care, the armed forces, prison or custody;
  8. people who are vulnerable because they have fled their home because of violence;
  9. A person who is homeless as a result of being a victim of domestic abuse. There is no requirement that the person must have ceased to occupy the accommodation for this category of priority need to apply. A person is considered homeless if accommodation is unreasonable to continue to occupy because it is probable that this will lead to domestic abuse against them or someone in the household.

The term ‘vulnerable’ is not defined in the legislation, but the Homelessness Code of Guidance (para 8.16) contains guidance and case law has considered how to define and interpret ‘vulnerable for example, Hotak v Southwark LBC; Kanu v Southwark LBC; Johnson v Solihull MBC [2015] UKSC 30. The Supreme Court judgment decided in these cases a homeless person is in priority need if they are vulnerable compared to the average person, not the average homeless person (Johnson vulnerability).

The test involves comparing the ability of the applicant to deal with the effects of being homeless with the ability of a hypothetical ordinary person to deal with the same situation. In order to be deemed vulnerable, the applicant must be:

  1. significantly more vulnerable than an ordinary person in need of accommodation; and
  2. likely to suffer greater harm in the same situation.

See also Appendix 1: Further Information, The vulnerability test.

Vulnerability in this context relates to a person’s vulnerability if they are not provided with accommodation, not their general ‘need of care and support’.

4.3.3 Section 189A: Assessments and Personalised Housing Plans where the person is homeless or threatened with homelessness.

Local housing authorities must carry out an assessment where an eligible applicant is homeless or threatened with homelessness. This should identify what has caused the homelessness or threat of homelessness, the applicant’s housing needs and any support they need in order to be able obtain and stay in new accommodation.

Following the assessment, the local authority must work with them to develop a personalised housing plan. This should contain actions for the local authority to help them secure new suitable accommodation. A copy of the assessment and the plan must be given to the person, and both must be reviewed whilst the local authority continues to have any duty to them.

Practically, the local authority must try to agree a written list of the actions that each party will take. If they cannot be agreed, the local authority must produce a record of the reasons for the disagreement and detail what steps the local authority will take and those steps expected from the applicant. Until a point at which the local authority decides it does not owe a duty to the applicant, it has to keep the assessment under review, together with the appropriateness of any agreement reached or steps taken.

4.3.4 Section 189B: Relief Duty

The local authority has a duty to provide support and help to all eligible people who are homeless. This is met by helping a person secure suitable accommodation, where they have a reasonable possibility of staying for at least six months. The relief duty can remain in place for up to 56 days. If the applicant is still homeless at the end of this period the local authority must decide what further duty, if any, is owed to them.

The relief duty applies to all eligible applicants who are homeless; it is not conditional upon them being in a priority group.

The local authority can consider a person’s local connection when a relief duty is in place. If they do not have a local connection to the local authority and have a safe local connection to another local authority area, the local authority can decide to refer their case to the other area.

4.3.5 Duty to help to secure accommodation

Housing authorities have a number of duties and powers to secure accommodation for an applicant. The HRA introduces a duty of ‘help to secure’ accommodation for all applicants under prevention and relief duties. This does not mean that the housing authority has a duty to directly find and secure the accommodation, but involves them working with an applicant to agree reasonable steps that they and the local authority will take to identify and secure suitable accommodation.

The prevention or relief duty will be met if any type of suitable accommodation can be found when helping the applicant to secure accommodation. It can often be met by helping them to secure a tenancy; it can also be met by helping them to secure any type of suitable accommodation, including accommodation occupied under a licence.

The local authority can secure suitable accommodation in the following ways:

  1. providing it themselves; or
  2. arranging that the applicant obtains it from some other person; or
  3. giving the applicant advice and assistance so that accommodation is available from some other person (in R v (Miah) v Tower Hamlets LBC [2014] EWHC 1029 advice to meet the duty then ends the duty).

The local authority must provide temporary accommodation for applicants who are in a priority need group whilst it performs the relief duty.

4.3.6 Section 191: Intentionally homeless

A person becomes intentionally homeless if they deliberately do something, or fail to do something that as a direct consequence means they no longer live in accommodation that was reasonable for them to stay in.

The local authority must be satisfied that all five elements of the intentional homeless (IH) test apply.

  1. What did the applicant do or fail to do?
  2. Did it lead to a loss of the accommodation as a consequence of an act or omission?
  3. Was there a termination or interruption in the occupation as distinct from a failure to take up accommodation?
  4. Was the accommodation available for the homeless person’s occupation?
  5. Would it have been reasonable for the homeless person to continue to occupy the accommodation?

A person will also be found to be intentionally homeless if they enter into any arrangement under which they are required to leave the accommodation which it would have been reasonable for them to continue live in, if the purpose of that arrangement was to enable them to claim assistance as a homeless person.

In considering whether a person deliberately becomes homeless the local authority has to ask whether the loss of accommodation would reasonably have been regarded as a likely consequence of that person’s deliberate conduct:

  • ‘deliberate’ relates to the act or omission;
  • ‘likely’ means a real or serious possibility;
  • the link between the act and the homelessness must be judged objectively;
  • the deliberate act must have contributed in some measure to the loss of the home.

There may be a number of causes of the homelessness, some of which may be ‘innocent’ but the applicant will still be IH if the local authority – on the balance of probabilities – is satisfied that homelessness was a likely consequence of a deliberate act. Examples are:

  • the applicant’s tenancy was not renewed by the landlord and was a reasonable result of the behaviour of not paying rent or withholding rent;
  • an applicant guilty of ASB or criminal behaviour is forced to leave their home because of i.e. threats. They are IH because the accommodation would have been reasonable to occupy but for ASB.

Where the homeless person took action or failed to act, there is a good faith test that has to be considered in regard to a deliberate act, that is, was the applicant acting honestly or were they genuinely ignorant of a relevant fact?

If it is decided that a person is intentionally homeless, this limits the duties and assistance the local authority can give them. At the most, if they are also in priority need, they will be provided with temporary accommodation for a reasonable period only. This period – usually around 28 days – is to allow them to make their own arrangements to secure alternative accommodation.

4.3.7 Section 195: The Prevention Duty

The local authority has a prevention duty to provide support and help to all eligible people who are threatened with becoming homeless within the next 56 days. This duty is often be met by providing assistance to enable a person to remain in their current home, where possible, however where this is not feasible it can be met by helping them move to another home in a planned way, without them becoming homeless.

This duty applies to all eligible applicants who are threatened with homelessness, it is not conditional upon the applicant being in a priority group and it does not require an applicant to have a local connection to the area. The duty remains in place for up to 56 days, although it can be longer, if required.

4.3.8 Section 195: A change to the meaning of ‘threatened with homelessness’

Under the HRA, households are considered to be threatened with homelessness if they are considered to be threatened with homelessness in the next 56 days. This period has been doubled from previous legislation in the HA, previously it was 28 days from date they presented for accommodation.

This is to require local authorities to intervene to provide assistance at an earlier stage, so there is increased opportunity to achieve a successful homelessness prevention outcome. The local authority is obliged to take reasonable steps to help the applicant secure that accommodation so it does not cease to be available for their occupation. In deciding the steps to take the authority must have regard to its own assessment.

4.3.9 Section 199: Local connection and a local connection for care leavers

An applicant has a local connection to an area if they are:

  1. normally resident in the area (usually for six of the past 12 months, or for three out of the past five years);
  2. employed in the area;
  3. have family associations to the area; or actual relationships are often considered more important than blood ties
  4. have other special circumstances that give them a connection.

A local connection is determined by the facts and circumstances at the date that the local authority completed its enquiries.

A care leaver aged under 21 who was previously in care in the area for at least 2 years has a local connection, even if they were placed there by another council.

They will also have a local connection if the are under 25 and get advice and support from the local authority Children’s Social Care department under a pathway plan.

If the pathway plan is provided by a county council, the care leaver will have a local connection to every local housing department in the county council area.

4.3.10 Section 213B: Duty to Refer

The HRA introduced a duty to refer, which is placed on other public sector bodies, not the local housing authority. Social care services, including adult social care, are subject to this duty.

The aim of this duty is to help early identification of households who are homeless or threatened with homelessness, and to build on / develop joint working relationships between organisations in order to effectively prevent and relieve homelessness. The following organisations are subject to the duty to refer, and must refer people who they come into contact with, who are experiencing homelessness or who are threatened with becoming homeless:

  • prisons;
  • youth offender institutions;
  • secure training centres;
  • secure colleges;
  • youth offending teams;
  • the probation service;
  • Job Centre Plus;
  • social service authorities;
  • emergency departments;
  • urgent treatment centres;
  • hospitals in their function of providing inpatient care;
  • the Secretary for Defence in relation to former members of the regular armed forces.

The organisation must first have consent from the person they are going to refer. The person must then nominate a local authority in England where they want the referral to be sent. The referral itself will not mean a homelessness application has been made.

4.4 Summary of the main provisions of HRA

  1. The legislation introduces requirements for local housing authorities to carry out homelessness prevention work with all those persons who are eligible for help and threatened with homelessness.
  2. The HRA changes the point at which a person is classed as being threatened with homelessness from 28 days to 56 days.
  3. It makes changes to the way local authorities assess and the point in time in which a person becomes homeless or is threatened with homelessness. The HRA requires local housing authorities to carry out an assessment of the applicant’s needs and that the steps agreed between the local housing authority and the applicant are set out in writing in the form of a personalised plan.
  4. A duty is placed on local housing authorities to take steps for 56 days to relieve homelessness by helping any eligible homeless applicant to secure accommodation.
  5. A further duty was introduced that is owed to certain applicants who deliberately and unreasonably refuse to co-operate with local housing authorities.
  6. The legislation specifies that local agencies should refer those persons who are either homeless or at risk of being homeless to local housing authority teams.
  7. Provisions are made for certain care leavers to make it easier for them to show they have a local connection with both the area of the local authority responsible for them and the area in which they lived while in care if that was different.

4.5 Applying the Equality Act 2010 in regard of Priority Need and Disability

The definition of disability in the Equality Act 2010 (EA) is “a person has a disability if s/he has a physical or mental impairment which has a substantial and long term adverse effect on that person’s ability”.

When making decisions about priority need under the EA, the local authority must ensure it has taken all steps to gather all relevant information relating to the applicant’s mental or physical disability.  Workers should undertake a full assessment interview with the applicant, focus on questions that relate to any physical or mental impairment and ask how the impairment might impact on them if they were to become or remain homeless.

The Supreme Court stated that the EA is ‘engaged’ when making decisions on vulnerability where the applicant has a relevant protected characteristic: age; disability; gender; gender reassignment; pregnancy and maternity; race; religion or belief and sexual orientation. The court accepted that on priority need a protected characteristic will be a disability and these questions should be considered:

  1. What is the extent of the applicant’s disability?
  2. What is the likely effect of the disability on the applicant when taken together with that person’s other problems?
  3. Is the worker satisfied that relevant third party inquiries have been undertaken into any mental or physical impairment to demonstrate that the applicant meets the requirements set down by the EA?

If the applicant is found not to have a priority need category the reasons must be set out.

The local authority may find an applicant comes under the definition for the disability protected characteristic in a priority need, but does not automatically become eligible because they meet the definition.

If a local authority reaches a decision that on the evidence they are not vulnerable, despite coming under the disability protected characteristic, it must justify the decision as a proportionate means of achieving a legitimate aim, which is to meet the obligation set by the homeless legislation to decide when a person’s disability makes a person vulnerable under the EA.

5. Useful Resources

5.1 Homelessness Code of Guidance for Local Authorities

The Homelessness Code of Guidance for Local Authorities provides statutory guidance that all local authorities must consider when carrying out their duties relating to homelessness and preventing homelessness. The code is issued specifically for local authority members and staff, including social care services (see Section 4.3.10, Section 213B: Duty to Refer).

The guidance includes information on preventing and tackling homelessness, including joint working between housing and other services to secure accommodation and provide support. It also covers the duty to refer, although it was published prior to the implementation of the HRA.

5.2 Other useful resources

  • National Homelessness Advice Service NHAS: Useful information and resources for local authority staff, housing providers and members of the public. Requires a log in to access some resources.
  • Shelter Legal: Detailed and useful resources on homelessness applications, legal duties, security of tenure, rents, benefits etc.

Appendix 1: Further Information

  1. Residential accommodation

In R v Kensington and Chelsea RLBC Ex p Kujtim [1999] CCLR 340 CA the Court of Appeal held that residential accommodation could include ‘ordinary’ housing accommodation. A duty to supply such accommodation arose where a person needed care and attention, including housing accommodation when it is not available. The need for care is a precondition for this duty. Although CA uses the phrase ‘care and support’ instead of the term under the National Assistance Act 1948 (NAA) ’care and attention’, it has been held that the case law under the NAA still applies.

In R (SG) v Haringey LBC [2015] EWHC 2579 (Admin) it was held a local authority needs only provide under CA a response to an accommodation related need.

Deputy High Court Judge Bowers “The service provided in a non-home environment, would be rendered effectively useless if the claimant were homeless sand sleeping on the street”.

2. The vulnerability test

The vulnerability test is practically applied by asking the following questions:

  1. What are the person’s problems?
  2. What is the impact of those problems on them?
  3. What is their ability to manage their problems by themselves and with the help of others?
  4. Taking into account investigations from questions 1-3 how would they suffer more harm than an ordinary person without access to a home? i.e. would they suffer more harm than you or I if they were to become homeless?
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RELEVANT CHAPTERS

Duty of Candour

Stage 2: Enquiry, Ill Treatment and Wilful Neglect

RELEVANT INFORMATION

Ill-treatment or wilful neglect offences – Sections 20 to 25 of the Criminal Justice and Courts Act 2015

1. Introduction

Sections 20 and 21 of the Criminal Justice and Courts Act 2015 are a part of the Government’s response to the public inquiry conducted by Sir Robert Francis QC into the events at Mid-Staffordshire NHS Foundation Trust (Report of the Mid Staffordshire NHS Foundation Trust  Public Inquiry, also known as the Francis Report). There were already offences in relation to the ill-treatment and wilful neglect of adults receiving treatment for mental disorder (under the Mental Health Act 1983) and of those who lack mental capacity. However, there was previously no equivalent specific offence in relation to those being cared for who had full mental capacity (see Mental Capacity chapter).

Under these sections of the Act, it is a criminal offence for an individual to ill treat or wilfully or deliberately neglect a person for whom they care, in their role of being a care worker.

‘Wilful’ means that the care worker has acted deliberately or recklessly in relation to the person who they are paid to care for.

‘Ill-treatment’ is also a deliberate act, where the individual knew that they were ill treating a person, or were being reckless as to whether they were.

Ill treatment and neglect are separate concepts. Ill treatment does not necessarily have to result in physical harm and can involve emotional and psychological damage – that the actions have caused or have the potential to cause to the adult and their family (see case law R v Newington1990, 91 Cr App R 254). It can also include a failure to protect the privacy and dignity of a vulnerable adult when the victim is unaware that they are being ill treated.

These offences apply to both organisations and individuals.

The Care Quality Commission (CQC) has a role to play as the regulator in setting standards and ensuring adults are safeguarded from abuse and improper treatment. CQC can prosecute registered care providers whom they have judged to have breached the standard. Criminal offences only apply to cases of wilful neglect where there is evidence of the worker or organisation acting or omitting to act deliberately, even though they know there is some risk to the adult as a consequence or because they do not care about that risk. Genuine errors or accidents by a care worker should not be caught within these offences.

2. Care Worker Offence

Under the Act a ‘care worker’ means an individual, who, is paid to provide health or social care. They may also be a director or be in a similar post within an organisation that provides health or social care.

‘Paid work’ means when a person is paid for carrying out care (see Appendix 1, Further Information, Paid work).

Health care includes all types of physical health or mental health care provided to adults. This also includes health care in relation to protecting or improving public health, and procedures that are similar to types of medical or surgical care but are not provided in connection with medical conditions which are excluded health care (see Excluded Healthcare) .

Social care includes all types of personal care, physical support and other practical assistance provided for people who need such care or assistance. This may because of:

  • age;
  • Illness;
  • disability;
  • pregnancy;
  • childbirth;
  • dependence on alcohol or drugs; or
  • any other similar circumstances.

This would not include a person who provided such care which was secondary to carrying out other activities.

A care worker found guilty of such an offence could receive a prison sentence of up to five years or a fine (or both); or for a less serious charge a prison sentence of up to 12 months or a fine (or both).

Unpaid family carers and friends cannot be charged with these offences. They may be investigated and charged under different legislation, however.

3. Care Provider Offence

The term ‘care provider’ means:

  • a corporation or association that provides and / or arranges health care (apart from excluded health care – see Section 2, above) or social care for an adult;
  • a person who is not the care provider, but provides health care or social care which has been arranged by the care provider, including where the individual does not provide care but supervises or manages those who do;
  • a director or similar post holder in an organisation which provides health care or social care;
  • a person who provides such care and employs or has arrangements with other people to assist them in providing such care.

A care provider commits an offence if:

  • a care worker who is caring for an individual (as part of the care provider’s arrangements) ill treats or wilfully neglects that individual;
  • if the care provider’s activities are managed or organised in a way which leads to a gross breach of a duty of care by the care provider to the individual who is ill-treated or neglected, and if that had not happened, the ill treatment or wilful neglect would not have occurred or would have been less likely to occur.

A person arranging for the provision of such care does not include someone who makes arrangements under which the provision of such care is secondary to carrying out other activities.

References made to providing or arranging the provision of health care or social care do not include making:

  • direct payments for community services and carers;
  • direct payments for health care;
  • direct payments for care and support.

4. Duty of Candour

See also Duty of Candour chapter

There is a requirement on health and social services to be open and honest with patients and service users when things go wrong. Professionals are expected to be candid with adults who use their services and their families when serious events occur and not obstruct fellow professionals who raise concerns.

The Francis Report recommends that healthcare providers must inform patients or other authorised persons as soon as practicable when they believe that the treatment of care provided has caused death or serious injury to that patient and provide information and explanation as the patient may reasonably request.

It also recommends a duty of candour on individual professionals to inform their employers where they believe or suspect that the treatment has caused death or injury. It is a criminal offence to obstruct a person in the performance of these duties or provide misleading information.

The Care Act includes a duty of candour as one of the requirements for providers registered with the CQC. All providers must act in open and transparent manner with adults who use their services and their families about their care and treatment.

There is also a requirement to notify and provide information and support to the adult or the person acting on their behalf where:

(i) an incident has resulted in or appears to have resulted in the death of an adult who uses the service ; or

(ii) caused severe harm or moderate harm or prolonged psychological harm to them.

The regulations also set out a notification requirement and it is a criminal offence for workers who commit breaches of the duty of candour.

Appendix 1: Further Information

  1. Meaning of Wilful

The meaning of “wilful “has been developed in the case of R v Sheppard [1981) AC the House of Lords  held that a man “wilfully” fails to provide adequate medical attention for [P] if he either

(a)  Deliberately does so knowing that there is some risk that P’s health may suffer unless he receives such attention; or

(b) Does so because he does not care whether P may in need of medical treatment, or not’

  1. Paid work

Paid work does not include:

  • payment in respect of the individual’s expenses;
  • payment to which the individual is entitled as a foster parent;
  • a benefit under social security legislation;
  • or a payment made under arrangements under Section 2 of the Employment and Training Act 1973 (arrangements to assist people to select, train for, obtain and retain employment).
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South Tyneside Safeguarding Adults Board & Safeguarding Children Partnership logos

RELEVANT SECTIONS

Safeguarding Enquiries Process

South Tyneside Safeguarding Adults Thresholds Guidance Tool (2023)

April 2024: This protocol has been reviewed and terminology updated to reflect that it is a joint protocol across Children’s and Adults safeguarding.

1. Introduction

In South Tyneside we pride ourselves on good partnership relationships, but in the event of any concerns about practice we would aim to resolve any disagreements or disputes at the lowest level of each safeguarding partner’s organisation.

The emphasis is on partners being respectful of each other’s position. As a joint and shared responsibility, the onus is on each partner to communicate with each other any significant changes in their agency that may impact on the effectiveness of the safeguarding arrangements, consult with each other and listen to each partner’s contribution. If matters cannot be resolved through discussion and negotiation between first or middle-line representatives, the issue will be brought to the attention of the South Tyneside Safeguarding Children Partnership (STSCP) and South Tyneside Safeguarding Adults Board (STSAB)

This guidance is aimed at colleagues across all services and agencies working with children/young people or adults. It relates specifically to inter-agency disagreement and does not cover disagreement within single agencies which should be addressed by their agency’s own escalation policy.

At no time should professional disagreement detract from ensuring a child/young person or adult is safeguarded – the child/young person or adult’s welfare and safety must remain the paramount concern throughout

Please note that this protocol does not apply to cases where there may be concerns about the behaviour or conduct of another professional that may impact on a child / young person’s or adult’s safety and well-being.  In such cases, reference should be made to the Allegations Management Process (children) or Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance (adults).

2. Definition

Professional challenge is a fundamental professional responsibility. In the context of this protocol, it is about challenging decisions, practices or actions which may impact on a child / young person or adult’s safety and wellbeing. Problem resolution is an integral part of professional co-operation and joint working to safeguard people.

Occasionally situations may arise when professionals within an agency consider that the decision made by professionals from another agency is not adequate or safe. Many professional challenges will be resolved on an informal basis by contact between the professional raising the challenge (or their manager) and the agency reviewing the challenge. However, where there is a need to, unresolved concerns or worries should be escalated using the protocol.

Disagreements could arise in several areas, but are more likely to be:

  • a difference of view in relation to levels of need;
  • a lack of understanding about roles and responsibilities;
  • quality and progression of safeguarding plans;
  • communication and information sharing;
  • management of risk.

3. Key Principles

The safety of the child / young person adult is the paramount consideration in any professional disagreement and staff should be mindful of the risks in considering escalation and resolve difficulties quickly and openly.

Professional disagreement is reduced by clarity about roles and responsibilities and there is value in exchanging and recognising differing professional views and expertise to achieve best outcomes.

Any learning should be applied to address any identified practice or policy issues.

A culture of respectful professional challenge is expected and the best way of resolving difference is through open and transparent discussion; where possible a face-to-face meeting between those concerned which will enable clear identification of the specific areas of difference and the desired outcomes for the child/young person or adult.

E-mail communication, whilst important, can be open to misinterpretation or make for stilted exchange of views.

Disagreement should be resolved at the lowest possible stage between the people who disagree but any worker who feels that a decision is unsafe should consult their manager or designated safeguarding lead, who should refer to Stage One of the pathway for escalation.

Please note: It should be acknowledged that differences in status and/or experience may affect the confidence of some workers to pursue this unsupported.

4. Timescales

The safety of the child / young person or adult must not be compromised by using the Escalation Policy.

All escalations and challenges should be accurately recorded on the child/ young person / adult’s record in line with your agencies recording policy, including reference to use of the stages set out in this protocol.

 It is expected that all issues will be resolved within a maximum of 5 working days and that feedback will be provided at every stage.

 Any practitioner who is worried about a decision / action should contact the practitioner who made the decision / took action, to express their views and worries and discuss the rationale for the decision. (Often differences are based on a misunderstanding of agency policy and lack of communication and as such can be resolved quickly).

If professionals are unable to reach agreement about the way forward, both practitioners should raise their concerns with their line manager within one working day and progress to Stage 1 of the Escalation Pathway.

Stage 1 – Immediate Resolution – Line Managers – within 1 day

The practitioner who raised the concerns should share this information with their line manager stating their evidence for the concern, what outcome they would like to be achieved and how they believe differences can be resolved. Without delay, the line manager will then contact the line manager of the practitioner who made the decision to try and negotiate a solution to the issue.

Stage 2 – Escalation and Resolution to Senior Manager /Service Manager / Named Designated Safeguarding Lead / Role of equivalent standing

This stage may involve a meeting between the agency raising the concern and the receiving agency (who made the original decision) to discuss the different views and find a solution that is person centred. Feedback should be provided to all involved and it may also be useful for individuals to debrief following some disputes in order to promote continuing good working relationships and identify possible training needs

At this point the STSCP / STSAB should be notified of the nature of the professional challenge (see Appendix 1) as the Chair for the Children Partnership and Independent Chair for the Adults Board have a role in monitoring issues identified and examining how policy and practice issues are being addressed.

Stage 3 – Escalation and Resolution by Head of Service / Headteacher / Chief Officer or Role of equivalent standing

At Stage 3 the Head of Service / person with equivalent role, will pass the information (including actions taken to attempt to resolve it so far and outcome expectations) to the relevant Head of Service / person of equivalent role, of the agency who made the original decision. Consideration should be given to the concerns raised and outline what action will be taken to the referring Head of Service / person of equivalent role. Feedback should be provided and if concerns remain, the matter should be passed to STSCP / STSAB Business Manager.

Stage 4 – Formal Consideration by STSCP /STSAB

Upon receipt of the information:

  • The STSCP / STSAB Business Manager to discuss with the STSCP Chair/ STSAB Independent Chair to determine how the issue should be addressed.
  • The role of the Chair of the Safeguarding Children Partnership / Independent Chair of the Safeguarding Adults Board in this process is a combination of arbitration and mediation dependent upon the circumstances.
  • The STSCP / STSAB will acknowledge receipt of the issue and inform the referrer of the plan of action.
  • The STSCP / STSAB Business Manager will ensure that all issues and subsequent actions will be recorded on the STSCP / STSAB Escalation and Challenge spreadsheet. This will ensure an accurate record of all challenges and outcomes is held and any themes will be considered on a 6 monthly basis by the STSCP / STSAB.

5. Recording and Reporting

Contemporaneous written records must be kept of all discussions, and these should be retained on the child/young person’s / adult’s case file/agency database. It is important that timely feedback is given to the person who raised the concern as to what action has been taken in response.

6. Quality Assurance

Issues referred via this protocol will be reviewed on a 6 monthly basis by the STSCP and STSAB Performance, Management and Evaluation sub groups.

Appendix A: Escalation Notification Form / Template

Escalation Notification to the South Tyneside Safeguarding Children Partnership and South Tyneside Safeguarding Adults Board (opens as Word document)

Appendix B: Escalation Flowchart

Escalation Flowchart for Adults and Children (opens as pdf)

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RELEVANT CHAPTER

Responding to Signs of Abuse and Neglect

Equality, Diversity and Human Rights in a Safeguarding Context

1. Introduction

Staff across all organisations must treat adults with care and support needs, and their carers, friends and family with dignity, compassion and respect at all times and in all circumstance.

Staff must adopt a culture of care that respects the privacy, dignity, culture and individuality of all patients under its care and staff (see also Equality, Diversity and Human Rights in a Safeguarding Context).

2. Principles

All staff must:

  • recognise the diversity, values and human rights of adults;
  • uphold and maintain their privacy, dignity and independence;
  • provide care, support and treatment in a way that ensures their dignity, and treats them with compassion and respect at all times;
  • ensure that they have privacy when they want it, treating them as equals;
  • provide any support they might need to be autonomous, independent and involved in their community;
  • help adults maintain relationships that are important to them
  • put adults at the centre of their care and support by enabling them to make decisions (see Making Safeguarding Personal chapter);
  • all communication with adults and their families must be respectful and compassionate. This includes using or facilitating the most suitable means of communication and respecting their right to engage or not to engage in communication;
  • provide information that supports them in the safeguarding process, or others acting on their behalf, to make decisions;
  • support adults, or others acting on their behalf, to understand the care and support provided, including risk and benefits and their rights to make decisions;
  • staff must make sure that they provide appropriate care and support that meets people’s needs, but this does not mean that care and support should be given if it would be against the consent of the person (see the chapters on Consent in Relation to Safeguarding and Mental Capacity);
  • address them in the way they prefer, including their favoured name;
  • have regard for the protected characteristics as defined in the Equality Act 2010, that is: age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation (see also Equality, Diversity and Human Rights in a Safeguarding Context).

3. Personalised Care and Support through Involvement

Adults should be involved in and receive care and support that respects their right to make or influence decisions. Staff should:

  • explain and discuss their care and support options with them in a way that makes sense to them;
  • respect their right to take informed risks, while balancing the need for preference and choice with safety and effectiveness (see Managing Risk);
  • ensure that things that are important to the adult in relation to their care and support are established as part of their assessment, development and review of their plans;
  • promote and respect their autonomy, privacy, dignity, compassion, independence and human rights at all times by:
    • placing their needs, wishes, preferences and decisions at the centre of assessment, planning and delivery of care and support;
      • respect their personal preferences, lifestyle and care choices;
      • when providing intimate or personal care, the organisation must make every reasonable effort to make sure that they respect the preferences of individuals in relation to who delivers their care and treatment, such as requesting staff of a specified gender;
    • have clear procedures followed in practice, monitored and reviewed that ensure staff understand the concepts of privacy, dignity, independence and human rights and how they should be applied;
    • ensuring that the need to maintain confidentiality or disclose information is taken account in the assessment of the individual circumstances (see South Tyneside Multi Agency Information Sharing Agreement);
    • actively listening to and involving adults, or others acting on their behalf, in decision making and ensuring there are clear records that evidence the decisions made and methods in which the decision was achieved;
    • provide information to help them, or others acting on their behalf, to understand their care and support, including the risks and benefits, and their rights to make decisions;
    • make adults aware of independent advocacy services wherever they are available, and cooperate with independent advocacy services (see Independent Advocacy);
    • know how to raise a concern or complaint about the organisation, and how it will be dealt with (see Whistleblowing).

4. Managing Risk through Effective Procedures about Involvement

Procedures must ensure that:

  • care and support options, and the risks and benefits of those options, are explained to the adult / their representative;
  • choices and preference of the adult are expressed by them or others acting on their behalf;
  • the choices of adults are respected and accommodated unless:
    • the choice places other people at risk of harm or injury;
    • it would not be reasonable to expect the service to have the resources needed to achieve the choice;
    • if to meet choice is not within the stated aims, objectives and purpose of the service provided;
    • the adult does not have capacity to make that decision or is subject to a legal restriction that prohibits them making a choice (see Mental Capacity and Consent in Relation to Safeguarding);
  • individualised assessments and plans of care and support are based on the adult’s needs, choices and preferences;
  • any reasonable adjustments are made so that the adult is enabled to be involved in decision making.
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This chapter outlines the main issues in relation to equality, diversity and human rights which should be applied when implementing safeguarding adults procedures and process, as well as all other aspects of providing care and support services to adults.

RELEVANT CHAPTER

Dignity, Compassion and Respect

RELEVANT INFORMATION

Equality and Human Rights, Care Quality Commission

Equally outstanding: Equality and human rights – good practice resource (Care Quality Commission)

Culturally Appropriate Care (Care Quality Commission) 

September 2021: This chapter has been amended to add a link to Culturally Appropriate Care published by the Care Quality Commission, as above.

1. Introduction

This chapter outlines the main issues and relevant legislation in relation to equality, diversity and human rights which should be applied when implementing safeguarding adults procedures and processes, as well as all other aspects of providing services to adults with care and support needs.

2. Equality Act 2010

The Equality Act 2010 ensures there is consistency in what an organisation does to provide services in a fair environment and comply with the law. This includes all the people who use its services, their family and friends and other members of the public, staff, volunteers and partner agency staff (see also 5.2, Protected characteristics).

The Equality Act references ‘protected characteristics’: all of which must be considered when implementing safeguarding procedures. These are

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

See Section 5.2, Protected characteristics for more information.

An organisation’s commitment to equality and diversity means that every person supported by it has their individual needs comprehensively addressed. They will be treated equally and without discrimination. This is regardless of any protected characteristics or another aspect that could result in them being discriminated against. The organisation is also committed to protecting individuals’ human rights. Failure to make reasonable adjustments in the care of a certain group with a protected characteristic (for example, a learning disability) may violate the Equality Act. Public bodies should have a process by which they consider how to promote equality.

3. Commitment to Equality, Diversity and Human Rights

The organisation should express its commitment to equality and diversity by:

  • respecting the ethnic, cultural and religious practices of people who use the service and making practical provision for them to be observed as appropriate;
  • reassuring people who use the service that their diverse backgrounds enhance the quality of experience of everyone who lives and works in any service provided by it;
  • protecting people’s human rights – treating them and their family and friends, fairly and with respect and dignity;
  • accepting adults who use the service as individuals;
  • supporting people to express their individuality and to follow their preferred lifestyle, also helping them to celebrate events, anniversaries or festivals which are important to them;
  • showing positive leadership and having management and human resources practices that actively demonstrate a commitment to the principles of equality and diversity;
  • developing an ethos throughout its service that reflects these values and principles;
  • expecting all staff to work to equality and diversity principles and policies and to behave at all times in non-discriminatory ways;
  • provide training, supervision and support to enable staff to do this;
  • having a code of conduct that makes any form of discriminatory behaviour unacceptable. This applies to both staff, people who use services and their family and friends, which is rigorously observed and monitored accordingly.

4. Care Quality Commission and Human Rights

‘Respecting diversity, promoting equality and ensuring human rights will help to ensure that everyone using health and social care services receives safe and good quality care.’ (Care Quality Commission)

The Care Quality Commission employs the commonly agreed ‘human rights principles’ in their inspection frameworks. These are sometimes called the FREDA principles:

  • fairness;
  • respect;
  • equality;
  • dignity; and
  • autonomy (choice and control).

These principles and standards should be at the heart of safeguarding process and in the planning and delivery of care to adults with care and support needs and their family and friends. The organisation should also encourage and support its staff to develop knowledge and skills and, where relevant, provide organisational leadership and commitment to achieve human rights based approaches.

The organisation should encourage positive practice and a learning culture that promotes human rights. Staff must take swift action if they think someone’s human right are being breached (see Responding to Signs of Abuse and Neglect chapter).

5. Guidance

5.1 Types of discrimination

All staff involved in the safeguarding process should be familiar with the following types of discrimination.

  • Direct discrimination occurs when a person is treated less favourably than others in similar circumstances on the grounds of race, colour, national or ethnic origins, sex, marital status, sexuality, disability, membership or non-membership of trade union, ‘spent convictions’ of ex-offenders, class, age, political or religious belief.
  • Discrimination by association applies to race, religion or belief, sexual orientation, age, disability, gender reassignment and sex. This is direct discrimination against someone because they associate with another person who possesses a protected characteristic (see Section 5.2, Protected characteristics below).
  • Perception discrimination is against an individual because others think they possess a particular protected characteristic. It applies even if the person does not actually possess that characteristic.
  • Indirect discrimination occurs when a condition or requirement is imposed which adversely affects one particular group considerably more than another.
  • Harassment is defined as unwanted, unreciprocated and / or uninvited comments, looks, actions, suggestions or physical contact that is found objectionable and offensive. Harassment is particularly liable to occur as part of sexual or racial discrimination.
  • Victimisation occurs when an employee is treated badly because they have made or supported a complaint or raised a grievance under the Equality Act, or because they are suspected of doing so. People are not protected from victimisation if they have maliciously made or supported an untrue complaint.

5.2 Protected characteristics

Under the Equality Act 2010 these are as follows.

  • Age: Where this is referred to, it refers to a person belonging to a particular age (for example 32 year olds) or range of ages (for example 18 – 30 year olds).
  • Disability: A person has a disability if they have a physical or mental impairment which has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities. The Act includes a protection from discrimination arising from disability. This states it is discrimination to treat a disabled person unfavourably because of something connected with their disability. The Equality Act places a duty on public bodies to promote equality of opportunity between disabled people and others. There is a duty to make reasonable adjustments for disabled people relating to the provisions of services and “encourage persons who share a relevant protected characteristic to participate in public life”.
  • Gender reassignment: A transgender person is someone who proposes to, starts or has completed a process to change their gender. The Act does not require a person to be under medical supervision to be protected – so a woman who decides to live as a man but does not undergo any medical procedures would be covered. It is discrimination to treat transgender people less favourably because they propose to undergo, are undergoing or have undergone gender reassignment than they would be treated if they were ill or injured.
  • Marriage and civil partnership: In England and Wales marriage is not restricted to a union between a man and a woman and includes a marriage between a same-sex couple. Same-sex couples and mixed-sex couples can also have their relationships legally recognised as ‘civil partnerships’. Civil partners must not be treated less favourably than married couples (except where permitted by the Act). The Act protects employees who are married or in a civil partnership against discrimination.
  • Pregnancy and maternity: Pregnancy is the condition of being pregnant or expecting a baby. Maternity refers to the period after the birth. Protection against maternity discrimination is for 26 weeks after giving birth, and this includes treating a woman unfavourably because she is breastfeeding.
  • Race: Race refers to a group of people defined by their race, colour, and nationality (including citizenship) ethnic or national origins.
  • Religion or belief: Religion has the meaning usually given to it but belief includes religious and philosophical beliefs including lack of belief (for example atheism). Generally, a belief should affect life choices or the way a person lives for it to be included in the definition. In the Equality Act, religion includes any religion. It also includes a lack of religion.
  • Sex: Both men and women are protected under the Act.
  • Sexual orientation: Whether a person’s sexual attraction is towards their own sex, the opposite sex or to both sexes. The Act protects bisexual, gay, heterosexual and lesbian people.

6. Human Rights Act 1998

See also Equality and Human Rights Commission

The Human Rights Act 1998 (HRA) lays down the fundamental rights and freedoms to which everyone in the UK is entitled. The rights set out in the European Convention on Human Rights (ECHR) are incorporated in the HRA. It sets out people’s human rights in different ‘articles’, which are all taken from the ECHR. They are:

  • Article 2: Right to life;
  • Article 3: Freedom from torture and inhuman or degrading treatment;
  • Article 4: Freedom from slavery and forced labour;
  • Article 5: Right to liberty and security;
  • Article 6: Right to a fair trial;
  • Article 7: No punishment without law;
  • Article 8: Respect for private and family life, home and correspondence;
  • Article 9: Freedom of thought, belief and religion;
  • Article 10: Freedom of expression;
  • Article 11: Freedom of assembly and association;
  • Article 12: Right to marry and start a family;
  • Article 14: Protection from discrimination in respect of these rights and freedoms;
  • Protocol 1, Article 1: Right to peaceful enjoyment of property;
  • Protocol 1, Article 2: Right to education;
  • Protocol 1, Article 3: Right to participate in free elections;
  • Protocol 13, Article 1: Abolition of the death penalty.

Human rights law applies to public bodies and other organisations carrying out functions of a public nature. A number of these articles relate to working with adults with care and support needs, in particular Articles 2;3;5;8.

The HRA can be breached in three ways by public bodies if they:

  • inflict explicit physical abuse or allow neglect of a person;
  • intervene in a person’s life unlawfully and disproportionately;
  • fail to intervene to protect a person from being abused or neglected by other persons.

6.1 Articles 2, 3, 5 and 8

6.1.1 Article 2 Right to Life

Article 2 applies in health and social care situations and requires an independent investigation into some deaths – coroner inquests – and may involve a breach of human rights with the state or public organisations implicated.

6.2 Article 3 Inhuman and Degrading Treatment

No one shall be subjected to torture or to inhuman or degrading treatment or punishment.

Degrading treatment would occur if it “humiliates or debases an individual showing a lack of respect for or diminishing his or her human dignity or arouses feelings of fear, anguish, or inferiority capable of breaking and individuals moral and physical resistance.” Pretty v UK [2002] 2FC 97

Article 3 is breached most frequently when public bodies carry out or are responsible for abusive care and treatment; that is allowing or ignoring actions when they should not have done so.

There is a positive duty under Article 3 for a public body to intervene when abuse is performed by one private individual against another person.

6.3 Article 5: Deprivation of Liberty

People who lack mental capacity are one of the categories when people can be deprived of their liberty (see Mental Capacity chapter and Deprivation of Liberty Safeguards chapter). Legal procedures are set out in the Mental Capacity Act 2005 (MCA) and the Mental Health Act 1983 and should be followed. If they are not adhered to, it may lead to a breach of Article 5.

A deprivation of liberty under the MCA describes a best interest decision made in regard to a person who lacks mental capacity to decide about care, treatment or living arrangements. Such deprivations must be legally authorised under the provisions of the MCA (sections 4A-4B) or by order of the Court of Protection.

6.4 Article 8: Respect for private and family life, home and correspondence

Article 8 protects a person’s right to respect for their private life, their family life, their home and correspondence (for example, letters, telephone calls and emails).

6.4.1 Private life

A person has the right to live their life privately without government interference. This is a broad concept as interpreted by the courts, and covers areas such as:

  • sexual orientation;
  • lifestyle choices;
  • how someone chooses to look and dress;
  • the right for someone to control who sees and touches their body. In health services, for example, staff cannot leave someone undressed in a ward, or take a blood sample without the person’s permission;
  • the right to develop a personal identity;
  • to make friendships and other relationships;
  • a right to participate in essential economic, social, cultural and leisure activities. In some circumstances, public bodies, such as the local authority, may need to help someone enjoy their ability to participate in society;
  • the media and others being prevented from interfering in someone’s life.
  • personal information (including official records, photographs, letters, diaries and medical records) being kept securely and not shared without the person’s permission, except in certain circumstances (see Data Protection chapter).

6.4.2 Family life

People have the right to enjoy family relationships without interference from government. This includes the right to live with their family and, where this is not possible, the right to have regular contact. This includes couples who are not married, between an adopted child and adoptive parent and a foster carer and foster child.

If a local authority makes an unjustified intervention in the life of person lacking mental capacity it may also breach Article 8: London Borough of Hillingdon v Neary [2011] EWHC 1377 (COP).

6.4.3 Home life

Everyone has a right to enjoy their existing home peacefully. Public bodies, therefore, should not stop a person from entering or living in their home without very good reason. They also cannot enter it without the person’s permission.

A right to home life does not mean, however, a right to be given housing.

6.4.4 Restrictions to Article 8

There are times when public bodies can interfere with someone’s right to respect for private and family life, home and correspondence. In such situations, the authority must be able to show that such action is lawful, necessary and proportionate in order to:

  • protect national security;
  • protect public safety;
  • protect the economy;
  • protect health or morals;
  • prevent disorder or crime; or
  • protect the rights and freedoms of other people.

Article 8 is not an absolute right. Interference with private life and family life is legally permissible but must be justified within the terms set out above.

A breach of Article 8 would occur if interventions are taken which are:

  • inconsistent with the relevant law;
  • consistent with the law but disproportionate and therefore unnecessary; or
  • for a purpose other than the criteria listed above.

6.5 Article 10 Freedom of Expression

Article 10 is the freedom to hold opinions and to receive and impart information and ideas without inference from the State. This right is not absolute but subject to several provisos. Restrictions can only be justified if they are for a specific purpose, for example:

  • public safety;
  • the prevention of disorder or crime;
  • the protection of health and morals;
  • the protection of the reputation or rights of others;
  • preventing the disclosure of confidential information.

The Care Act guidance warns local authorities against “abusive interventions that risk breaching the adult’s right to family life if not justified or proportionate“ Care and Support Statutory Guidance (Department of Health and Social Care).

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RELEVANT INFORMATION

Mental Health Act 1983

Mental Health Act 1983 Code of Practice

1. Introduction

The Mental Health Act (MHA) is the current law which provides legal powers for the admission, detention and treatment of a person against their will in respect of mental illness. Where a person is detained against their will this is commonly known as ‘being sectioned’.

The Act is an extensive legislative framework about which this chapter provides an introduction and basic details of the most commonly known and used sections within the adult social care remit.

The Mental Health Act 1983 was reformed in 2007 which saw a number of key changes to the original Act which placed a larger focus on public protection and risk management. See Appendix 1: 2007 Amendments to the 1983 Act, for information about changes to the original legislation.

2. Who does the Mental Health Act 1983 apply to?

The MHA provides ways of assessing, treating and caring for people who have a serious mental disorder that puts them or other people at risk. It sets out when:

  • people with mental disorders can be detained in hospital for assessment or treatment;
  • people who are detained can be given treatment for their mental disorder without their consent (it also sets out the safeguards people must get in this situation); and
  • people with mental disorders can be made subject to guardianship or after-care, under supervision to protect them or other people.

Most of the MHA does not distinguish between people who have the mental capacity to make decisions and those who do not. Many people covered by the MHA have the capacity to make decisions for themselves.

Decision makers will need to decide whether to use either the MHA or MCA to meet the needs of people with mental health problems who lack capacity to make decisions about their own treatment. Where someone with a mental health disorder is subject to a Community Treatment Order (CTO) or Guardianship under the MHA, and lacks capacity, they may have a Deprivation of Liberty Safeguards in place; otherwise a person cannot be subject to the two frameworks at the same time.

3. Parts of the Act

The Mental Health Act 1983 is split into ten parts:

  1. The Application of the Act
  2. Compulsory Admission to Hospital and Guardianship
  3. Patients Concerned in Criminal Proceedings or Under Sentence
  4. Consent to Treatment
  5. Treatment of Community Patients not Recalled to Hospital
  6. Mental Health Review Tribunals
  7. Removal and Return of Patients Within the United Kingdom
  8. Management of Property and Affairs of Patients
  9. Miscellaneous Functions of Local Authorities and Secretary of State
  10. Offences
  11. Miscellaneous and Supplementary

The Mental Health Act 1983 was reformed in 2007 when a number of key amendments were made placing a greater focus on public protection and risk management. See Appendix 1: 2007 Amendments to the 1983 Act.

These parts are the ones most commonly used and key to adult social care practice:

  • Compulsory Admission to Hospital and Guardianship;
  • Miscellaneous Functions of Local Authorities and Secretary of State;
  • Miscellaneous and Supplementary.

4. Part 2: Compulsory Admission to Hospital and Guardianship

4.1. Section 2 Admission for Assessment

Allows for:

  • a person to be detained in hospital for assessment of their mental health;
  • treatment to be forcibly administered as part of the assessment period (excluding use of Electro-Convulsive Therapy (ECT);
  • a detention period of up to 28 days, however discharge can be arranged sooner.

Section 2 cannot be renewed. If further detention is required beyond the 28 day period, assessment under section 3 should be considered. In certain cases where there may be issues relating to a person’s nearest relative, Section 2 can be extended by the powers of the Court until such decision regarding the nearest relative are resolved.

4.1.1 Criteria

For a person to be detained under section 2 they must have:

  • been assessed by two doctors – one of whom must be section 12 approved. It is preferable that at least one of the doctors involved in the assessment has previous acquaintance with the person being assessed;
  • both doctors need to be of the opinion that compulsory admission is required and must complete a medical recommendation;
  • there must be no longer than five clear days between each of the medical assessments, for example if an examination is completed on a Monday, the five days are not inclusive of this day (meaning Tuesday to Saturday are clear days therefore Sunday is the last possible day for the second medical examination);
  • the Approved Mental Health Professional (AMHP) must be in agreement with the two doctors’ recommendations and have completed a valid application for admission;
  • the AMHP must complete the application for admission within 14 days of the latter dated medical recommendation;
  • a person’s nearest relative is also able to make an application for admission.

4.1.2 Appeal

Patients have the right to appeal against the detention within the first 14 days.

4.2 Section 3: Admission for treatment

For a person to be detained under section 3 the criteria for section 2 must all be met. Section 3 can be used where a person is well known to mental health services and it is clear what illness is to be treated and therefore no assessment period is required.

Alternatively, it may be used due to the need for continued detention after the 28 day period of section 2.

4.2.1 Provisions

The Act allows the following provisions:

  • a person to be detained in hospital for treatment of their mental health. Appropriate medical treatment must be available;
  • forcible administration of treatment (excluding use of ECT. Where there is non-compliance with medication this will need to be reviewed by a second opinion appointed doctor (SOAD) after three months.;
  • a detention period of up to six months, after which it can be renewed for a further six months and on a 12 monthly basis thereafter.

4.2.2 Appeal

Patients have the right to appeal against the detention within the first six months.

4.3 Section 4 – Admission for Assessment in case of emergency

4.3.1 Criteria

Section 4 is used in emergency situations where is it deemed not practicable to arrange two doctors and assess under section 2.

Unlike assessment for sections 2 and 3 there needs only to be one doctor involved – preferably one whom previous acquaintance. An AMHP is still required to make an application.

4.3.2 Provisions

The Act allows the following provisions:

  • detention period of up to 72 hours following which further assessment by a second doctor should be arranged and the decision made whether to detain under section 2 or to arrange discharge;
  • treatment can be refused, however where there is concern regarding capacity to consent, treatment can be provided in the best interests of the individual detained. It can also be provided where it is necessary to prevent harm to themselves or to others.

4.3.3 Appeal

There is no right of appeal against section 4.

4.4 Section 5: Application in respect of a patient already in hospital (holding powers)

The Act:

  • provides powers to doctors and nurses to prevent a person from leaving hospital where by doing so there may be a risk posed to the individual themselves or to others as a result of the individuals mental health;
  • may be used to prevent informal patients from leaving a mental health ward or prevent a person from leaving a general ward where they may be receiving treatment for a physical condition.

There are two parts to section 5:

4.4.1 Section 5 (2)

This is often referred to as doctors’ holding powers. The provisions are:

  • it gives the doctor in charge of the individuals the power to detain for up to 72 hours;
  • further assessment by an AMHP and second doctor should be arranged as soon as possible and the decision made whether to detain under a section of the M HA or to arrange discharge;
  • section 5 (2) cannot be renewed.

4.4.2 Section 5 (4)

This is often referred to as nurse’s holding powers. The provisions are:

  • it gives certain nurses the power to detain for up to six hours;
  • a doctor should be requested to attend as soon as possible;
  • section 5(4) ends when the doctor arrives. The doctor must assess if the person can be transferred onto section 5(2) or whether the person can remain on an informal basis;
  • section 5(4) cannot be renewed.

4.5 Section 7: Application of Guardianship Order

Guardianship gives someone (usually a local authority social care department) the exclusive right to decide where a person should live. However in doing so they cannot unlawfully deprive the person of their liberty. Where restrictions amount to a deprivation, authorities should seek to apply for a DoLS authorisation to run concurrent with the Guardianship Order (see Deprivation of Liberty Safeguards).

The guardian can also require the person to attend for treatment, work, training or education at specific times and places, and they can demand that a doctor, approved mental health professional or another relevant person have access to the person wherever they live.

Guardianship can apply whether or not the person has the capacity to make decisions about care and treatment.

It does not give anyone the right to treat the person without their permission or to consent to treatment on their behalf.

4.6 Section 17: Leave of absence from hospital

The Act makes the following provisions:

  • the Responsible Clinician (RC) to grant a detained patient leave of absence from hospital;
  • leave can be provided as escorted or unescorted and the time allowed is controlled by the RC;
  • leave can be used to allow a person to have home leave including overnight stays and can often be useful to trial how a person is likely to function in the community when discharged from hospital.

A person is still a detained patient when section 17 is in place.

4.7 Section 17A: Community Treatment Orders

Community Treatment Orders (CTO’s) are used to support people in the community that have mental health needs and require continued treatment under supervision.

The aim of the community treatment or was to reduce the number of ‘revolving door’ patients who would typically become non-compliant with treatment once discharged from hospital, and as a result experience deterioration in their mental state often resulting in further admission.

The provisions are:

  • CTO’s can only be used where a person is detained under section 3, 37, 45A, 47 or 48;
  • a CTO allows for conditions to be attached to a person’s discharge;
  • any individual considered for a CTO should have a degree of understanding in relation to the conditions attached as they must comply with these conditions in order to avoid recall to hospital;
  • CTO timeframes mirror those of Section 3, that is six months, six months, annual;
  • an AMHP needs to be in agreement with the proposal of a CTO before it can be enforced.

4.8 Section 26: Nearest Relative

The MHA provides safeguards to those who are detained, one of these being the role of the nearest relative (NR).

The NR is different from next of kin and is identified using following:

  • husband, wife or civil partner;
  • son or daughter;
  • father or mother;
  • brother or sister;
  • grandparent;
  • grandchild;
  • uncle or aunt;
  • niece or nephew.

Determining a person’s NR can be complex, however to simplify it whoever appears first in the list defaults to the role.

The NR must be over 18, and where there are both parties available, for example mother and father, the eldest would fulfil the role.

The NR has the right to request that a MHA assessment is completed; they are able to make an application for detention and can also request that their relative is discharged from hospital.

An identified NR can be displaced by the courts if it is deemed that they are unsuitable. The NR is also able to delegate the role and function.

5. Part 9: Miscellaneous Functions of Local Authorities and the Secretary of State

5.1 Section 117 Aftercare – Introduction

Section 117 of the Mental Health Act 1983 (2007) imposes a duty upon local authorities and Integrated Care Boards (ICBs) to provide aftercare services for anybody who has been detained under Sections 3, 37, 45A, 47 or 48 of the Mental Health Act (MHA). This includes patients granted leave of absence under section 17 and patients being discharged on community treatment orders (CTOs). The Care Act 2014 implemented some changes to the MHA.

As Section 117 enforces a duty on the local health authority and adult social care services to provide care to meet eligible needs, Section 117 needs that arise directly because of or from the person’s mental disorder and are likely to prevent a deterioration in their condition and therefore lead to a readmission. If a person has additional social care needs, such as a physical disability, that do not arise because of a mental disorder, the usual social care eligibility criteria under the Care and Support Statutory Guidance would need to be applied to these needs.

If, at any point, it becomes apparent that a person who is be eligible for Section 117 aftercare has been paying for services, they can reclaim these payments as long as with clear evidence is provided of their detention.

6. Part 11: Miscellaneous and Supplementary

6.1 Section 135 – Warrant to search and remove to a place of safety

6.1.1 Section 135 (1)

The provisions are:

  • professionals have the power of entry to a person’s private dwelling for the purpose of assessment under the MHA;
  • for entry to be gained by force if required under the powers of a warrant issued by the county court;
  • for a person to be removed to a place of safety for the purpose of assessment or where appropriate, remain in their own home.
  • An AMHP, a police officer and a doctor is required to be present for the execution of a 135 (1) warrant.

6.1.2 Section 135 (2)

The provisions are:

  • for forcible entry if required to access a person who is liable to be detained under the MHA or who need to be retaken to hospital (for example if they have gone absent without leave from the ward when detained and have returned home and refusing to allow entry);
  • a warrant is again required to act out these powers of entry, however an AMHP or doctor is not required to execute the warrant under this section.

6.1.3 Section 136 – Removal of Mentally Disordered Persons Without a Warrant – Police Powers of detention

The provisions are:

  • section 136 is an emergency power which allows police officers to remove a person from a public place to a place of safety for the purpose of further assessment under the MHA where there are concerns that a person may be suffering from mental illness and in need of immediate care and / or control. The timeframes of section 136 were reduced from 72 to 24 hours in December 2017;
  • if a person is initially seen by a doctor before the AMHP has coordinated a full assessment and it is deemed that there is no evidence of mental illness, the person must be discharged from the 136 immediately;
  • a person can be discharged with or without follow up from services once assessed or may be detained under the MHA.

Appendix 1: 2007 Amendments to the Mental Health Act 1983

The key amendments to the Act were as follows.

The Fundamental Principles – Section 118 of the Act says that the Code of Practice (which was given legal stature as part of the reform) must provide a statement of principles to inform all decision making within the remit of the mental health act.

Chapter 1 of the Code of Practice for England outlines the following guiding principles:

  • purpose principle;
  • least restriction principle;
  • respect principle;
  • participation principle;
  • effectiveness, efficiency and equity principle.

Section 1: Definition of mental disorder – The definition of mental disorder in Section 1 of the Act was split into 4 classifications; psychopathic disorder, mental illness, mental impairment and severe mental impairment.

The 2007 Act broadened the term of mental disorder:

“mental disorder” means any disorder or disability of the mind.

Prior to the changes to the Act there were grounds to detain those with Learning Disability under mental impairment and severe mental impairment. The amendment now makes clear that the disability itself does not meet the criteria for detention unless it is:

“associated with abnormally aggressive or seriously irresponsible conduct on his part”

Professional roles – The role of the Approved Social Worker (ASW) was opened up to healthcare professionals including nurses, occupational therapists and psychologists. It was renamed the Approved Mental Health Professional (AMHP).

The role of the Responsible Medical Officer (RMO) became that of the Responsible Clinician (RC).

Supervised Discharge /Community treatment Orders – Section 25A Supervised Discharge of the 1983 Act was abolished other than for those already subject to it and was replaced with the introduction of section 17A Community Treatment Orders (CTO’s).

Introduction of Appropriate Medical Treatment – The 1983 Act stated that treatment had to be likely to be effective upon a person’s condition which allowed for a greater degree of detentions to take place, whereas the Act now concurs that treatment is only to be provided where there is purpose outlining that the purpose of any treatment is to:

“alleviate, or prevent a worsening of, the disorder or one or more of its symptoms or manifestations” (section 145).

The definition of medical treatment was also changed itself to outline that medical treatment can be provided in the absence of medical supervision.

Those of 16 and 17 years of age and Parental Responsibility – The 2007 Act introduced the notion that any person aged 16 or 17 who is deemed to have capacity cannot be detained on basis of parental consent – outlined in section 131 MHA.

Appendix 2: The Policing and Crime Act 2017

Further to the 2007 Amendments to the MHA 1983, the introduction of the Policing and Crime Act 2017 has more recently had an impact on the application of the Act:

  • section 136 powers can be exercised anywhere other than in a private dwelling;
  • it is unlawful to use a police station as a place of safety for anyone under the age of 18 in any circumstances;
  • a police station can only be used as a place of safety for adults in specific circumstances, which are set out in regulations;
  • the maximum detention is 24 hours (unless a doctor certifies that an extension of up to 12 hours is necessary);
  • before exercising a section 136 power police officers must, where practicable, consult one of the health professionals listed in section 136(1C), or in regulations made under that provision;
  • a person subject to section 135 or 136 can be kept at, as well as removed to, a place of safety. Therefore, where a section 135 warrant has been executed, a person may be kept at their home (if it is a place of safety) for the purposes of an assessment rather than being removed to another place of safety;
  • police officers can search persons subject to section 135 or 136 powers for protective purposes.
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RELEVANT CHAPTERS

Cuckooing

Modern Slavery

Safeguarding Enquiries Process

RELEVANT INFORMATION

County Lines: Criminal Exploitation of Children and Vulnerable Adults (Home Office)

National County Lines Coordination Centre, County Lines Awareness Video – a 10 minute video discussing the county lines methodology and how this is impacting children, young people and vulnerable adults, partners, law enforcement and society.

NHS, County Lines: Coercive Internal Concealment – a rapid read document on internal concealment.

Office for Health Improvement and Disparities, Working definition of trauma-informed practice – guidance on trauma-informed practice

College of Policing, Adults at risk – authorised professional practice for policing on adults at risk

Crown Prosecution Service, CPS county lines offending guidance – sets out the approach of the police and the CPS to county lines offending, including the safeguarding of vulnerable persons, and the investigation and prosecution of criminal offences.

April 2024: This chapter which provides information on how to spot signs that an adult with care and support needs is being exploited and what action to take if you have concerns, has been updated throughout.

1. Introduction – What is County Lines Exploitation?

County lines is a way of distributing illegal drugs which uses violence and exploitation. It is a form of abuse. It commonly involves children and vulnerable adults, who may have care and support needs, being forced to deliver drugs and money or weapons to drug dealers or drug users, either in the local area or in other counties.

Adults can also be forced to use their homes to store drugs, a practice known as cuckooing or forced home invasion (see Cuckooing chapter). Criminal exploitation has a devastating impact on victims, families and local communities.

The government definition of county lines is:

County lines is a term used to describe gangs and organised criminal networks involved in exporting illegal drugs into one or more importing areas within the UK, using dedicated mobile phone lines or other forms of ‘deal line’. They are likely to exploit children and vulnerable adults to move and store the drugs and money and they will often use coercion, intimidation, violence (including sexual violence) and weapons. (Serious Violence Strategy, Home Office).

This chapter provides guidance for frontline staff so they can recognise the signs of criminal exploitation and know how to respond so that victims get the support and protection they need.

Where concerns relate to the criminal exploitation of a child or young person under 18 years, the Safeguarding Children Partnership procedures should be followed.

2. Forms of Exploitation

County lines exploitation always involves some form of power imbalance which is used by the perpetrators to force, coerce, groom or entice victims into county lines activity. Methods used include:

  • offering an exchange: the victim carries drugs in return for something they need or want such as money, drugs, protection, a sense of belonging or identify, supposed friendship or affection;
  • physical violence or threats of violence: victims and their families are intimidated or punished. Weapons may be used;
  • abduction or kidnapping: victims are forcibly moved and held away from their homes;
  • emotional abuse or psychological coercive control – the victim’s movements are controlled using threats / manipulation;
  • sexual abuse and exploitation – this can be experienced by people of any gender;
  • blackmail – victims are forced to commit a crime so it can be held over them in the future if they do not comply with the exploiters;
  • social media / messaging apps – these can be used to target and communicate with victims, often by building false friendships online or to post fraudulent job adverts;
  • cuckooing / forced home invasion –criminals, usually drug dealers, take over the homes of vulnerable adults, including care leavers or those with addiction, physical or mental health issues. The property becomes the base for the criminal activity. It can be in rented or private properties, student accommodation or commercial premises. See Cuckooing chapter.
  • coerced internal concealment / plugging – victims are forced to conceal drugs or SIM cards internally, so they can be moved without detection by others, especially the police;
  • debt bondage –victims are made to repay money they owe by transporting drugs. Victims are often groomed and provided with money or goods which they then find out they have to pay back;
  • financial exploitation – victims are coerced, manipulated or deceived into moving money obtained through crime.

Remember

Vulnerable adults who have been groomed and exploited into county lines have not freely chosen to be involved and cannot consent to being exploited.

Just because an adult receives something in exchange for their involvement, this does not make them any less of a victim.

3. Who is at Risk of Exploitation?

Any vulnerable adult could be a victim of county lines exploitation, as exploiters continually adapt who they target to avoid detection.

Sex / gender – people of all genders can be exploited. Women are often exploited to perform different roles and can experience other forms of harm (such as sexual exploitation).

Ethnicity – people from all ethnicities and nationalities are targeted.

Location – county lines are widespread across the country, in both rural and urban areas. It can involve the movement of drugs across county borders from one area of the UK to another, but also to supply local drugs markets, and operate in the same town, city or county. County lines grooming can take place in a range of settings, including people’s homes, public spaces, schools and universities, prisons and youth offender institutions as well as online.

The risks of exploitation can be higher for particular groups of adults including those:

  • in contact with the criminal justice system, even for minor offences (the arrest of a victim can be an opportunity for the police to identify safety and welfare concerns);
  • who have experienced neglect, physical abuse, sexual abuse or exploitation, domestic abuse or trauma and who lack a safe or stable home environment. This includes care leavers;
  • who are socially isolated or experiencing social difficulties. The lack of friends or a support network can make it even harder for people to get help;
  • who do not have much money and / or ways of getting money legally (for example, do not find it easy to get jobs) ;
  • who are homeless or have insecure accommodation;
  • with connections to other people in gangs;
  • with a physical or learning disability or who are neurodivergent or experiencing mental health issues. It can be harder for these victims to recognise they are being exploited or to ask for help;
  • with insecure immigration status.

These risk factors do not cause the adult’s exploitation into county lines, but they can create an imbalance of power which exploiters then seek to abuse. However, adults with none of these risk factors and who are not known to services can also be exploited and are referred to as ‘clean skins’ by exploiters.

4. Signs to Look Out For

It is unlikely that a victim will report their own exploitation. This may be because they do not see themselves as victim or feel able to tell anyone that they are being exploited. They are also likely to be scared to ask for help because they are scared of serious repercussions from their exploiters.

However, practitioners who are working with adults are well placed to spot possible signs of county lines exploitation, which include the following.

Behaviour

  • Going missing, being unwilling to say where they have been or being found in areas they have no obvious connections to.
  • Self harm or significant changes in emotional wellbeing, behaviour or personality.
  • Isolation from social networks.

Possessions

  • Suddenly having new clothes, money or mobile phones.
  • Receiving and making lots of phone calls or texts, having multiple phones or SIM cards.
  • Carrying or storing weapons.
  • Using drugs or possessing drugs and drug paraphernalia / equipment.
  • Having train tickets for unusual journeys.
  • Having a bag or rucksack that they won’t put down / leave.

Appearance

  • Having unexplained injuries, for example cigarette burns.
  • Inappropriate online relationships, or being secretive.

Signs of being made to hide items inside them

  • Refusing food or drink.
  • Possession of lubricants and condoms.
  • Dishevelled appearance / stained clothing.
  • Being physically unwell (victims may require immediate medical help).

Debt bondage / financial exploitation

  • Large or unexplained sums of cash or deposits into bank accounts.
  • Unusual financial transactions.
  • Asking for money / stealing to pay back a debt.

If the practitioner has any concerns about changes in an adult’s behaviour or lifestyle, they should discuss these with them, and record details in the adults record (see Case Recording chapter).

5. Taking Action

Any concerns that a vulnerable adult is at risk of county lines exploitation require a safeguarding response.

If a person is at immediate risk of harm, the police should be contacted by calling 999.

If the person is not at immediate risk of harm, staff should talk to the adult and then concerns should be shared with the local authority adult safeguarding team (see Let’s Talk Team, Local Contacts) and the police. Use professional curiosity to gently ask the adult questions, they are likely to be reluctant to disclose information due to fear of repercussions (see also Professional Curiosity chapter).

This might involve the practitioner contacting the designated lead for safeguarding adults in their own organisation, who will then make a safeguarding adults referral; or, they could contact adult social care directly.

The local authority and partners agencies will then consider whether action is required to protect the adult victim. This may include a discussion about whether the person has care and support needs, if they have mental capacity (see Mental Capacity chapter) and if they do, whether inherent jurisdiction applies in their case. This is when a person with mental capacity is coerced or unduly influenced by another person, which restricts their ability to freely make their own decisions.

The adult should be at the centre of these discussions and any decisions that are taken during the safeguarding or inherent jurisdiction process. See Making Safeguarding Personal chapter.

Local authorities and the police have tools and powers to remove the exploiters and help victims., including applying for closure orders or injunctions on the cuckooed properties. All concerns should be recorded in the adult’s records along with details of all actions that have been taken and decisions that have been made (see Case Recording chapter).

If a practitioner is not satisfied with the local authority response to their concerns, the Escalation and Challenge Protocol should be followed.

5.1 Modern slavery and the National Referral Mechanism

Criminal exploitation is a form of modern slavery. The National Referral Mechanism (NRM) provides a framework for identifying and referring potential modern slavery victims and ensuring they receive appropriate support.  First responder organisations, which includes the local authority and the police (see Modern Slavery chapter, appendix 1), should refer adult victims of modern slavery to the NRM if they give their consent to this.  Even if the adult does not consent to the NRM referral, there is still a ‘duty to notify’ the Home Office that a potential victim of modern slavery has been identified. Full details can be found in the Modern Slavery chapter.  Any referral to the NRM or notification to the Home Office should come after the appropriate safeguarding steps have been taken and in light of the multi agency discussions held.

6. Practice Points

Put victims first –adults who are being exploited by county lines, they may look like they are agreeing to be involved in the criminality, but they may not actually recognise that they are being exploited. Practitioners should remember that vulnerable adults who have been groomed, coerced, manipulated and exploited into criminal activity have not freely chosen to be involved and therefore cannot consent to being exploited. They should be seen as victims first and foremost. Trauma informed approaches should be used, and the adult should be involved in the safeguarding process and next steps to build their trust (Office for Health Improvement and Disparities, Working definition of trauma-informed practice – guidance on trauma-informed practice).

Understand the risks – professional curiosity is important when working with adults who may be a county lines victim. Practitioners should keep a log of activity and save any evidence.  Information should be shared with other professionals to gather the full picture.

Work in partnership with other organisations – collaboration and information sharing are essential to protect victims and disrupt offenders.

Appendix 1: County Lines Posters

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REGULATION

Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20: Duty of Candour

1. Introduction

Duty of candour relates to an organisation being open and transparent with people who use its services and other relevant people (that is those who are acting lawfully on the person’s behalf) in relation to care and treatment. An organisation should be open and honest when things go wrong.

It applies to all NHS trusts, foundation trusts, special health authorities and all other service providers or registered managers.

Specific requirements must be followed in relation to an adult’s care and treatment, including:

  • informing people about an incident;
  • providing reasonable support;
  • providing truthful information;
  • giving an apology if procedures have not been followed or things go wrong.

2. Openness and Transparency

The organisation must promote a culture that encourages candour, openness and honesty at all levels. This is an integral part of a culture of safety that supports organisational and staff learning. This commitment to openness and transparency extends to all levels of the organisation, from senior and middle managers, care and support workers and ancillary staff, including temporary staff. These policies and procedures support a culture of openness and transparency, as they can be accessed by adults and their families as well as by staff.

Staff operating at all levels must understand their individual responsibilities in relation to the duty of candour, and are supported to be open and honest with adults and apologise when things go wrong. Staff should receive appropriate training, and there should be arrangements in place to support staff who are involved in a notifiable safety incident. In cases a manager is made aware that something untoward has happened, they should treat the allegation seriously, immediately consider whether this is a notifiable safety incident and take appropriate action (see Section 3, Notification Process following an Incident).

2.1 Bullying

The organisation should be committed to taking action to tackle bullying and harassment in relation to duty of candour, and must investigate any instances where a member of staff may have obstructed another in exercising their duty of candour. A possible breach of the professional duty of candour by staff who are professionally registered, including the obstruction of another in such a duty, may lead to an investigation, disciplinary action and referral to the Care Quality Commission and / or their professional body.

3. Notification Process following an Incident

When a notifiable safety incident has occurred, the adult and / or relevant person must be informed as soon as reasonably practicable after the incident has been identified.

The organisation should inform its regulator and / or commissioner of any unintended or unexpected incident that occurred in respect of an adult when providing regulated activity that, in the reasonable opinion of a health care professional:

  • appears to have resulted in:
    • the death of the adult, where the death relates directly to the incident rather than to the natural course of their illness or underlying condition (see Safeguarding Adult Reviews);
    • an impairment of the sensory, motor or intellectual functions of the adult which has lasted, or is likely to last, for a continuous period of at least 28 days;
    • changes to the structure of the adult’s body;
    • the adult experiencing prolonged pain or prolonged psychological harm; or
    • the shortening of the life expectancy of the adult; or
  • requires treatment by a health care professional in order to prevent:
    • the death of the adult; or
    • any injury to the adult which, if left untreated, would lead to one or more of the outcomes mentioned above.

Where the degree of harm to the adult is not yet clear but may fall into the above categories in future, the adult and / or relevant person must be informed of the notifiable safety incident. There must be appropriate arrangements in place to notify the adult who is affected by an incident if they are aged 16 and over and lack the mental capacity to make a decision about their care or treatment (see Mental Capacity chapter). A person acting lawfully on behalf of the adult must be notified as the relevant person where they are under 16 and lack the mental capacity to make a decision regarding their care or treatment. A person acting lawfully on behalf of the adult must be notified as the relevant person, upon the adult’s death.

Other than the situations outlined above, information should only be disclosed to family members or carers where the adult has given their consent. A step by step account of all relevant facts known about the incident at the time must be given, in person, by one or more member of staff including a service manager as relevant. This should include as much or as little information as the adult and / or relevant person wants to hear, be jargon free and explain any complicated terms. The account of the facts must be given in a manner that the adult and / or relevant person can understand. Staff should consider whether interpreters, advocates, or other communication aids should be used, while being conscious of any potential breaches of confidentiality in doing so.

Staff must also explain to the adult and / or relevant person what further enquiries they will make. One or member of staff should give a meaningful apology, which is an expression of sorrow or regret, in person, to the adult and / or relevant person. In making a decision about who is most appropriate to provide the notification and / or apology, the organisation should consider seniority, relationship to the adult, and experience and expertise in the type of notifiable incident that has occurred. Following the notification of the incident given face to face, the relevant person must receive written notification of the incident, even though enquiries may not yet be complete. This must contain all the information that was provided at the face-to face meeting, including an apology and as well as the results of any enquiries that have been made since. The outcomes or results of any further enquiries and investigations must also be provided in writing to the adult and / or relevant person through further written notifications, if they wish to receive them.

The organisaiton must make every reasonable attempt to contact the relevant person through all available means of communication. All attempts to contact the relevant person must be documented (see Section 5, Record Keeping). If the relevant person does not wish to communicate with the organisation or a senior manager, their wishes must be respected and a record of this must be kept. If the relevant person has died and there is nobody who can lawfully act on their behalf, a record of this should also be kept. The organisation is not required by regulation to inform an adult when a ‘near miss’ has occurred and the incident has resulted in no harm to that person.

4. Action following an Incident

The organisation must give the adult and / or relevant person all reasonable support necessary to help overcome the physical, psychological and emotional impact of the incident. This could include all or some of the following:

  • treating them with respect, consideration and empathy;
  • offering the option of direct emotional support during the notifications, for example from a family member, a friend, a care professional or a trained advocate;
  • offering help to understand what is being said, for example, through an interpreter, non-verbal communication aids, written information, Braille etc;
  • providing access to any necessary treatment and care to recover from or minimise the harm caused where appropriate;
  • providing the adult and / or relevant person with details of specialist independent sources of practical advice and support or emotional support / counselling;
  • providing the adult and / or relevant person with information about available impartial advocacy and support services, their local Healthwatch and other relevant support groups, for example Cruse Bereavement Care and Action against Medical Accidents (AvMA), to help them deal with the outcome of the incident;
  • arranging for care and treatment from another professional, team or provider if this is possible, if the adult and / or relevant person wishes;
  • providing support to access the organisation’s complaints procedure.

See also South Tyneside Multi Agency Information Sharing Agreement

5. Record Keeping

See also Case Recording.

The organisation must keep a record of the written notification, along with any enquiries and investigations and the outcome or results of the enquiries or investigations. Any correspondence from the adult and / or relevant person relating to the incident must be responded to in an appropriate manner and a record of communications should be kept.

6. Organisational Learning

The organisation should ensure a culture in which it learns from incidents at all levels in order to ensure the future protection and safety of adults who use its services.

7. Training and Support

See also Safeguarding Training for Staff and Volunteers

Staff should receive appropriate training and there should be arrangements in place to support staff who are involved in a notifiable safety incident.

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SOUTH TYNESIDE SPECIFIC INFORMATION

Northumbria Police Missing Vulnerable Adults and the Herbert Protocol (see also Herbert Protocol Form)

RELEVANT CHAPTERS

Mental Capacity

Deprivation of Liberty Safeguards

RELEVANT INFORMATION

Dementia: assessment, management and support for people living with dementia and their carers (NICE) 

Dementia Friends website

1. Introduction

As people get older, they may have problems with loss of memory. While it is normal for memory to be affected by factors such as age, stress, tiredness, menopause and certain illnesses and medications, there could be underlying medical reasons for these memory issues – such as a dementia – that require investigation and treatment.

The following statistics relate to dementia in the UK:

  • there are currently an estimated 1,000,000 people living with dementia;
  • the number of people with dementia is predicted to rise to 1.4m by 2040;
  • one in 14 people aged over 65 have dementia. This rises to one in six for those aged over 80;
  • the financial cost is £42 billion per annum;
  • women are more likely than men to develop dementia in their lifetimes, partly due to the fact that women live longer than men.

(Alzheimer’s Society; Dementia Statistics Hub).

2. What is Dementia?

Dementia is a common condition which is more likely to develop with age, usually occurring in people over the age of 65.

It is a syndrome (which is a group of related symptoms) associated with an ongoing decline of brain function. It affects:

  • memory loss;
  • thinking speed;
  • mental agility;
  • language;
  • understanding;
  • judgement.

An adult with dementia may experience different mental changes. This can include losing empathy with other people, hearing or seeing things that are not real (auditory or visual hallucinations), becoming up and down in their mood (being less emotionally stable), not having any interest in things and losing interest in past activities. Social situations may become more difficult as their personality changes.

Where there are concerns that an adult with dementia no longer has mental capacity, safeguards should be put in place to ensure decisions are made in their best interests (see also Mental Capacity chapter).

The speed at which a person’s symptoms get worse and the way their condition develops depends on the cause of the dementia, as well as their overall health. This means that the symptoms, the rate of progress and experience of dementia are different for each person. There is currently no cure for dementia. However, there are treatments for dementia, including medication, that can help with managing symptoms

An adult who is experiencing a number of the symptoms related to dementia may find it difficult to continue being independent and may need help from family or friends, including help to make decisions.

If a person – or their family or friends – is worried that they may be developing dementia, they should see their GP.  Following investigations, early diagnosis can help people get the right treatment, care and support and help those close to them to prepare, access support for themselves and plan ahead. With treatment, care and support many adults can lead active and fulfilled lives.

3. Different Types of Dementia

3.1 Alzheimer’s disease

Alzheimer’s disease is the most common cause of dementia, it causes changes to the chemistry and structure of the brain, which results in brain cells dying off. Common symptoms of Alzheimer’s disease and other forms of dementia include:

  • memory loss – especially recent events, such as forgetting messages, remembering routes or names and asking questions repetitively;
  • increasing difficulty with everyday tasks and activities;
  • becoming confused in places they don’t know / don’t know well;
  • having difficulty finding the right words;
  • having difficulty with numbers and / or paying in shops, particularly with cash;
  • changes in personality and mood;
  • feeling depressed.

Early symptoms of dementia (sometimes called cognitive impairment) are often mild and may get worse very gradually. This means that some people – and their family and friends – do not notice them or take them seriously for quite a while.

3.2 Vascular dementia

Vascular dementia is caused when the oxygen supply to the brain fails and brain cells die as a result. This can either happen suddenly such as after a stroke, or over time  as a result of a number of small strokes. Symptoms can start quite suddenly and quickly get worse, although they can also develop gradually over many months or years.

People with vascular dementia may also experience stroke-like symptoms, including weakness or paralysis on one side of their body.

3.3 Dementia with Lewy bodies

This form of dementia is caused by tiny round structures that develop inside nerve cells in the brain, which leads to a deterioration of brain tissue. Dementia with Lewy bodies has many of the symptoms of Alzheimer’s disease, but people with the condition also usually experience:

  • periods of being awake or drowsy, or fluctuating levels of confusion;
  • seeing things that are not there (visual hallucinations);
  • becoming slower in their way they move.

3.4 Frontotemporal dementia

In this type of dementia, damage usually occurs in the front part of the brain, so an adult’s personality and behaviour are more affected to start with than their memory. An adult with this type of dementia may become less sensitive to other people’s emotions, perhaps seeming cold and insensitive. They may also behave in a way that is out of character for them, such as making inappropriate comments. Some adults also experience language problems, which may result in them not speaking, speaking less than usual or having problems finding the right words.

4. Symptoms in Later Stage Dementia

As dementia progresses, memory loss and difficulties with communication often become severe. In the later stages of their life, the affected adult is unlikely to be able to care for themselves and will require constant care and attention.

  • Memory symptoms: adults may not recognise close family and friends, remember where they live, know where they are, and find it impossible to understand simple bits of information or carry out basic tasks or follow instructions.
  • Communication problems: adults may have increasing difficulty speaking and may eventually not be able to speak at all.
  • Mobility problems: adults may become less mobile, eventually becoming unable to walk and may be mostly in a bed and / or chair.
  • Incontinence: urinary incontinence is common (wetting), and some people will also experience faecal (bowel) incontinence.
  • Eating, appetite and weight: losing their appetite and having difficulties eating or swallowing are common. This may lead to choking, and an increased risk of chest infections. People with these problems may lose weight as well.

As well as issues of mental capacity, care should be taken to make sure the adult’s human rights are not breached if they lack capacity to consent to care and treatment (see the chapters on Mental Capacity, Deprivation of Liberty Safeguards and Equality, Diversity and Human Rights in a Safeguarding Context).

5. Adults with Care and Support Needs

Getting a dementia diagnosis is a frightening time, and receiving the right treatment and care and support early when a person first shows symptoms, are some of the key points in the Care Act 2014 (see Promoting Wellbeing).

Whilst an adult with an early diagnosis of dementia may not require care and support services, they will inevitably do so as the disease progresses. Their carers may also require assessment and a support plan from the local authority.

Some adults with dementia will be self-funders, when care and support is paid by them or a family member for example. They may not then want an assessment by the local authority.

Where an adult is assessed by the local authority, a care and support plan should be developed with them, to make sure that they are able to state what their needs are and what they want to happen wherever possible, as well as those of their carer (see Care and Support Planning chapter).

6. Carers

See also Carers chapter

Dementia is a very distressing illness for the person’s family and friends, as well as the person themselves. They often see the personality and abilities of their loved one change so much, sometimes to the point of being unrecognisable to how they were before. For couples who have been together a long time, for example, it is very upsetting when their partner or spouse no longer recognises them, or the person physically or verbally abuses them.

When adults with dementia are being looked after at home by family or friends, it is very important that they receive all the multi-agency support needed to be able to best care for them for as long as they are able. This should include an assessment by the local authority if they wish, and the development of a support plan for the carer to put in place to support them to continue caring for their loved one, if this is what they wish to do. This may include home visits from care workers to help with care and support needs, day centre placements, short breaks in residential homes or having someone live in at home whilst they go on holiday.

Carers may feel a range of emotions, including not wanting their loved one to go into long-term care, when in reality they are struggling to cope looking after them at home. A review of the carer’s support plan should include discussions about the longer term future for the adult and their carer, Staff should sensitively discuss with them what may happen, and any preferences they may have, if there comes a time when they can no longer care for the adult.

Both the adult’s care and support plan and the carer’s support plan should include plans for what should happen if the carer cannot care for the adult on either a short term (illness for example) or permanent basis, including planning for what may happen in an emergency situation.

7. Making Advance Decisions

People can make some decisions in advance to make sure their wishes and views are respected should they lose mental capacity in the future, as a result of dementia for example. This includes decisions about their health care treatment and authorising lasting power of attorney in relation to their health and welfare and / or property and financial affairs. See the chapter on Planning Ahead for Health and Social Care Decisions.

8. Safeguarding Adults with Dementia

As discussed above, common symptoms for adults with dementia include memory loss, disorientation, confusion, communication difficulties, behavioural issues, low mood and cognitive impairment. One or more of these factors can put an adult who may be at risk of suffering or experiencing abuse or neglect.

They are vulnerable to abuse or neglect because:

  • dementia can affect a person’s ability to communicate or can make them confused, so they may be unable to tell anyone about what is happening to them;
  • they may not be able to manage their own financial affairs, Icf an unsuitable person takes this over for them, it gives them opportunity to steal money or other possessions;
  • they can be susceptible to psychological or physical abuse because carers cannot cope – either on a temporary or long term basis – and for example become angry, shout, care for them roughly or are otherwise unkind;
  • they can be targeted by abusers who take advantage of their condition and know they may be unable to refuse them or give in to people who are bossy and over-bearing;
  • the adult may forget about the abuse that has happened and not tell anyone.

As the condition progresses and the adult’s ability to self-protect will lessen.

Where there are safeguarding concerns, see the Safeguarding Enquiries Process section.

9. Training and Supervision

Training should be available for all staff working directly with adults with dementia, but also to other frontline staff to ensure they have an awareness and understanding of the issues that are important for both adults and their carers when managing the person’s symptoms.

This is particularly important considering the expected rise in the number of people who will be affected by dementia over the next 10 years.

Staff supervision sessions need to recognise the difficulties that working with adults with dementia can present for staff, who are involved in supporting both them and their carer. The symptoms of dementia can result in behaviour that is difficult to manage, whilst also being emotionally distressing for the individual member of staff.

Support for these issues needs to be available for staff through supervision, as well as external sources of specialised support where required.

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RELEVANT CHAPTER

Stage 1: Concerns

Safeguarding: What is it and Why does it Matter?

RELEVANT INFORMATION

Pressure ulcers: how to safeguard adults (Department of Health and Social Care)

Helping to Prevent Pressure Ulcers: A Quick Guide for Registered Managers of Care Homes (NICE)

April 2024– This section has been updated throughout to reflect the revised Department of Health and Social Pressure ulcers protocol and guidance. Information on the Pressure Ulcer Review Process (PURP) used by staff within the South Tyneside and Sunderland NHS Foundation Trust has also been added.

1. Introduction

In January 2024, the Department of Health and Social Care (DHSC) published an updated protocol on the process to be followed when it is identified that an adult has a pressure ulcer, including how to assess if a safeguarding concern should be raised with the local authority.

The protocol notes an increased concern about pressure ulcers in all settings, and a lack of clarity about when it is appropriate to raise a concern with the local authority adult safeguarding team, in relation to a section 42 safeguarding enquiry.

The protocol aims to promote awareness of pressure ulcers across the social care workforce, so that more can be done to prevent their occurrence and enable a speedy response. It makes clear that – in most cases – the appropriate response will be led by health practitioners, and not involve adult safeguarding processes. The protocol is accompanied by an adult safeguarding decisions guide which should be completed by a registered nurse. If responses to questions in the guide give a total score of more than 15, then concerns should be shared with the local authority adult safeguarding team.

2. What are Pressure Ulcers?

Pressure ulcers (also called pressure sores or bed sores) are an injury that break down the skin and underlying tissue. They are caused when an area of skin is placed under pressure. They usually form on bony parts of the body, such as the heels, elbows, hips and tailbone (coccyx, at the base of the spine).

Signs of a pressure ulcer include:

  • discoloured patches of skin that do not change colour when pressed – such patches are usually red on white skin, or purple or blue on black or brown skin;
  • a patch of skin that feels warm, spongy or hard;
  • pain or itchiness in the affected area of skin.

Pressure ulcers usually develop gradually but can sometimes appear over a few hours. They can become a blister or open wound. If left untreated, they can get worse and eventually reach deeper layers of skin, muscle and bone.

People are at more risk of developing pressure ulcers if they:

  • have problems moving / are not very mobile;
  • have had a pressure ulcer before;
  • have been seriously ill in intensive care or have recently had surgery;
  • are underweight.
  • have swollen, sweaty or broken skin.
  • have poor circulation or fragile skin.
  • have problems feeling sensation or pain.

Other issues include:

  • substandard care provided by staff;
  • poor communication between carers and nurses;
  • ineffective multi-disciplinary working;
  • lack of access to required resources such as equipment and low staffing numbers.

Pressure ulcers can also occur because of neglect. This may be the deliberate or unintentional failure of a carer or member of staff to provide appropriate and adequate care and support. This can include:

  • ignoring a person’s medical or physical care needs;
  • failing to provide access to appropriate healthcare and support services;
  • withholding essentials a person may need for good skin health, such as medication, adequate nutrition and regular changes of position.

3. Preventing Pressure Ulcers

Pressure ulcers cause distress to adults and their families, but most can be prevented. While treating and responding to pressure ulcers will mainly be health led, preventing pressure ulcers is the responsibility of everyone involved, as many of those who are at risk of pressure ulcers will be receiving services and support from staff working across the social care sector.

To prevent pressure ulcers, all health and social care practitioners involved in the planning, commissioning and delivering of health and social care to an adult, need to be able to spot the risks and take appropriate, speedy action.

Assessments of adults, including risk assessments, should look at the likelihood of pressure ulcers developing and describe actions that will be taken to prevent them. This applies to adults living at home as well in registered care home settings.

3.1 Providing information and advice

If the person who is at risk of pressure ulcers has mental capacity (see Mental Capacity chapter), they should be given advice and information about self-care and preventing skin damage. However, it is important to make sure the person:

  • has understood the advice;
  • can put the advice into practice;
  • has the necessary equipment and knows how to use it;
  • can understand what may happen if they do not follow advice.

If it appears that the adult is not looking after themselves or their environment, staff should ask their manager or safeguarding adults lead for advice (see also Self Neglect Guidance).

Family or friends carers or care workers should also be given training and information on how to prevent skin damage and pressure ulcers, and guidance on how to spot the signs that an ulcer may be developing.

4. Taking Action when a Pressure Ulcer is Identified

Where there is concern that a pressure ulcer has developed, an appropriate member of staff should explain this to the adult and their family members as appropriate and ask their views. Responses to pressure ulcers should always have the person at the centre and fully involve them (or their representative) and family.

Responding to pressure ulcers will mainly be an issue for health practitioners, rather than a safeguarding enquiry led by the local authority.  It is not appropriate or necessary for adults with pressure ulcers to be routinely referred to the local authority (see Section 4.2, When safeguarding concerns should be raised with the local authority).

Where there are concerns about the quality of a service and possible poor practice, these should usually be raised with the service provider in the first instance, then escalated to the local authority, Integrated Care Board or Care Quality Commission (CQC).

4.1 Initial steps

If there are concerns that an adult has a pressure ulcer, the member of staff involved should (in discussion with the adult and their family) refer them to appropriate healthcare services so they can access the treatment they require and action to prevent further damage to their skin.

A clinician, usually a nurse, will document how the skin damage developed. If the person has recently been transferred from another service, the organisation which identified concerns about the pressure ulcer should contact the previous care provider for information.

There should be a review within the organisation / service / provider, to identify if there are any lessons which could prevent the occurrence of pressure ulcers in the future. Very few cases will need a safeguarding concern to be raised with the local authority, most will not require such action (see Section 4.2 When safeguarding concerns should be raised with the local authority).

Where the pressure ulcer appears to be the result of unintentional neglect by an unpaid family or friend carer who is struggling to provide care, the most appropriate response will be to revise the package of care and ensure the carer has support and equipment to be able to care for the adult safely.  Conversations with carers about this can be difficult, especially where carers have been dedicated in providing care but were not given – or have forgotten or otherwise not followed – advice and support to prevent pressure ulcers.

4.2 When safeguarding concerns should be raised with the local authority

Most adults with pressure ulcers do not usually require a safeguarding referral / safeguarding processes as they require interventions and responses from health professionals.

The protocol requires that the Safeguarding Concern Assessment Guidance is used in cases of adults with ‘severe’ damage, to assess whether it may be appropriate for staff to also share their concerns with the local authority adult safeguarding team.

4.2.1 Defining Severe Damage

Pressure ulcers are given a category (or grade) from one to four to indicate the extent of the wound. For more information, see Categories of Pressure Ulcer (PDF, 1.22MB), with four being the most severe.

Pressures ulcers are classed as severe damage when:

  • there are multiple ulcers of category (or grade two)
  • there is a single case of category (or grade) three-four (or unstageable or deep tissue injury)

4.2.2 Action when there is severe damage

Within 48 hours of identifying a pressure ulcer which is classed as ‘severe damage’, the Safeguarding Concern Assessment Guidance should be completed by a registered nurse with experience in wound management. The nurse completing the assessment should not be directly involved with the care of the adult.

The safeguarding adult decision guide contains six questions which give an initial score. This can be used to help inform decision making about whether to escalate safeguarding concerns. The threshold for raising a concern with the local authority is a score of 15 or above – but the score should be used alongside professional judgement.

The six questions in the adult safeguarding decision guide are:

  1. Has the patient or service user’s skin deteriorated to either category 3, 4 or unstageable, or multiple sites of category 2 ulceration from healthy unbroken skin, since the last opportunity to assess or visit?
  2. Has there been a recent change, that is within days or hours, in their clinical condition that could have contributed to skin damage? For example, infection, pyrexia, anaemia, end of life care (skin changes at life end), critical illness.
  3. Was there a pressure ulcer risk assessment or reassessment with an appropriate pressure ulcer care plan in place, and was this documented in line with the organisation’s policy and guidance?
  4. Is there a concern that the pressure ulcer developed as a result of the informal carer wilfully ignoring or preventing access to care or services?
  5. Is the level of damage to skin inconsistent with the patient or service user’s risk status for pressure ulcer development? For example, low risk, category (or grade) 3 or 4 pressure ulcer.

Answer question 6a if the patient or service user has capacity to consent to every element of the care plan:

6a. Was the patient or service user able to follow the care plan having received clear information regarding the risks of not doing so?

Answer question 6b if the patient or service user has been assessed as not having mental capacity to consent to any or some of the care plan:

6b. Was appropriate care undertaken in the patient’s best interests, following the best interests checklist in the Mental Capacity Act Code of Practice? This should be supported by documentation, for example, capacity and best interest statements and record of care delivered.

A body map should be used to record skin damage. Photographs can also be taken, with consent from the adult or their representative. The photograph should only show the ulcer, not other uninvolved parts of their body; care and sensitivity must be taken to protect the adult when taking such images.

Please note: Staff working in South Tyneside and Sunderland NHS Foundation Trust (STSFT) use the Pressure Ulcer Review Process (PURP) which also assists in identification of whether a safeguarding referral for pressure damage is required.

4.2.3 Assessment score and next steps

If the decision guide score is 15 or higher (which is a concern for safeguarding), then the following action is required:

  • discuss with the person, family and / or carers that there are safeguarding concerns, explaining why and that a safeguarding enquiry has been raised;
  • refer to the local authority, with completed safeguarding pressure ulcer decision guide documentation, or own agency internal assessment tool outcome (for staff working in South Tyneside and Sunderland NHS Foundation Trust this could be Pressure Ulcer Review Process (PURP) documentation);
  • follow local pressure ulcer reporting and investigating processes;
  • record the decision in the person’s case records.

If the decision guide score is under 15, then the follow action is required:

  • discuss with the person, family and / or carers and explain reason why it is not being referred for a safeguarding enquiry;
  • explain why it does not meet criteria for raising a safeguarding concern with the local authority, but stress the actions which will be taken to treat the adult’s ulcer and prevent any further skin damage;
  • action any other recommendations identified and put preventative or management measures in place;
  • follow local pressure ulcer reporting and health investigation processes;
  • record the decision in the person’s case records.

Once a safeguarding adults concern is raised with the local authority, staff in the safeguarding adults team will decide whether a section 42 enquiry is required and inform the adult, family members, organisation / provider of the next steps (see Safeguarding Enquiries Process).

Appendix 1: Resources

Body map for Initial Recording

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This chapter provides information for multi-agency practitioners about how to keep safe, both professionally and personally, when using social media.

RELEVANT INFORMATION

Using Social Media Wisely, Health and Care Professions Council

1. Introduction

This guidance provides information about how to minimise risk to yourself, and others, whilst using social media sites. Commonly used social media sites include Facebook, Twitter, Instagram, TikTok and YouTube, through which users create online communities to share information, ideas, personal messages, and other content such as videos and photographs.

As a health or social care professional it is your responsibility to protect yourself as far as possible from allegations of wrongdoing online and whilst using digital technology, to avoid potentially inappropriate or damaging situations. As your job involves direct work with adults and their families who may be experiencing challenging and stressful circumstances, it is possible that some people may post information online about staff or the service that is wrong or upsetting.

It is vital therefore that, in order to protect the reputation of the organisation and staff, the response is always professional, proportionate and measured.

In such situations, managers may need to respond to and take action against those posting such material; guidance is provided below to help protect staff and volunteers working with the public.

2. Steps to Minimise Risk

2.1 Privacy settings and passwords

Check your privacy settings across all social networks. This can be done by going to ‘Settings’ and reviewing the current privacy settings. Updating privacy settings is vital to being able to protect yourself online and is just as important as keeping a credit card safe, for example.

The privacy settings of some social media sites can be set up to send posts just to particular groups, such as close friends, rather than all ‘friends’. Such options are worth considering when thinking about sharing information that you would not necessarily want all people to know.

Remember some information cannot be hidden however tight privacy settings. Names and profile images will always be visible on Facebook for example, so choose images or photos carefully.

By logging out of your social networks and then searching for yourself you can see how your profile appears to the public.

Regularly update your passwords. Do not use the same one across all social media accounts. This will help avoid someone hacking into your account and posting inappropriate status updates or images.

You can also make it more difficult to be found online, by changing your name or surname for example.

2.2 Connect wisely

Many people have far more friends on social media than they know personally. But it is wise only to connect with people that you know and trust. Even people you know, however, may post comments or share material that you do not like or agree with.

In such cases think about whether to ‘unfriend’ that person rather than be associated with someone whose views you do not share.

If it is someone you know and like, discuss their posts with them if you find it uncomfortable.

Consider the purpose of the site, and use it accordingly. For example, LinkedIn is for professional connections. It is best, therefore, not to accept requests to connect if the message contains suspicious text or the person seems to have no connections, location, education or vocation similar to you.

2.3 Post, share and access wisely

2.3.1 Personal information

Think carefully before you post photos and text.

If you would not say it in public or to your manager, or want them to see certain images, you should not put it on social media however tight your privacy settings. Online friends can share or repost / re-tweet your updates, so you can lose control of what you say and display.

Remember, some things are best only shared in person or by telephone or even not at all, not via social media including email.

It is illegal to access or download material that promotes or shows criminal behaviour. Do not access any illegal or inappropriate websites on your personal computer or mobile phone, not even for personal or professional research purposes. This includes illegal or inappropriate images of children, some pornography or extremist websites.

Photos and texts sent to mobile phones and tablets can also be shared by others, so be careful what you send to others or what images you allow people to take of you. Sometimes images are accompanied by personal information, including name, address and links to their social media profiles. Sharing certain private images or films may be an offence under the Criminal Justice and Courts Act 2015. It applies both on and offline, and to images which are shared electronically or more traditionally so includes uploading of images on the internet, sharing by text and email, or showing someone a physical or electronic image.

Be careful using social media whilst under the influence of alcohol. Whilst your own posts can be edited the next day, there is often not much that can be done about other people’s replies.

Take care when in contact with others via web cam internet sites (for example chat rooms, message boards, social networking sites and newsgroups). Avoid inappropriate communication with anyone you think may be under 18, or anyone with whom who you may be considered to be in a position of trust. Avoid inappropriate communication with those who you do not know. Adults can pose as children using interactive technology; likewise some children can pose as adults.

2.3.2 Professional Information

See also Using Social Media Wisely, Health and Care Professions Council and Professional Standards Guidance, Social Work England

Posting information in relation to adults with whom you work, or their family or friends, is allowed. This is likely to be a breach of data protection legislation and confidentiality requirements (see Data Protection: Legislation and Guidance chapter), and even if it is illegal, it is professionally unethical and may result in disciplinary action being taken. For example, families have seen and subsequently made formal complaints about social workers who – whilst not disclosing any personal information – have posted following court cases which have found in the local authority’s favour.

Posting information about work colleagues of any grade, whilst not illegal, is not advised. It can damage working relationships and cause difficulties in the work environment. Again, it may lead to disciplinary action being taken.

Consider also the possible implications of out of office hours discussions with colleagues via social media about controversial issues such as politics, for example. Working relationships can sometimes be negatively affected by such disagreements.

2.4 Review content

If you have used social media accounts over a number of years, it may be useful to review earlier entries to see if there is any content you posted when you were younger that you would not now post. If so, it would be best to delete it.

Check what others post about you, as this also contributes to your social media profile even if you did not post it yourself. If you are not happy with being tagged in a particular photo or status update, contact the person or organisation concerned via messaging or email (rather than via a public discussion) and politely ask them to remove it, explaining why.

Getting content taken down by the social media company can be difficult and may have to involve the police, which should only be reserved for extreme cases.

2.5 Act wisely

Whilst you should always share personal information with caution, in particular do not contact adults or their families via personal email, social media or telephone. This includes former users of the service. If you wish to keep in contact with any such person, only use work emails or telephone numbers to communicate with them. Discuss your intention with your line manager in advance, and seek their advice.

In order to further protect yourself, do not geotag or location tag your photographs.  Whilst the photos might not be easily identifiable, the location could lead to identification and let others know your whereabouts including your home address or those of your family and friends.

Ensure you follow your organisation’s Acceptable Use Policy / IT and email procedures. If you breach any part, report it immediately to your manager or other designated member of staff, as set out in the policy.

If there is any incident regarding the use of social media that concerns you, report it immediately to your line manager. Document it as soon as possible, according to your workplace procedures.

4. In Summary

Use common sense and professional judgement at all times to avoid circumstances which are, or as importantly could be viewed by others, to be inappropriate.

Remember, computers, tablets and mobile phone technology may be the virtual world, but they very much impact on real life. Treat people the same through electronic communications as you would on a personal basis.

Do’s

  • Think carefully before you post anything online;
  • Search on your own name to see what others can see about you and take action if there is anything that makes you feel uncomfortable;
  • Protect and regularly change your passwords;
  • Regularly review your privacy settings;
  • Make it more difficult to be found online (for example, change your surname).

Don’ts

  • Use inappropriate language;
  • Expect your friends or family to know how to protect your online reputation and how information they may post could impact on you professionally;
  • Have a public social media presence – do not set your privacy settings to public unless relevant;

Tag yourself or allow yourself to be tagged photos or videos;

Accept or send friend requests to adults who you have met through the course of your work who use services, their family or friends.

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RELEVANT INFORMATION

Statutory Guidance on Joint Strategic Needs Assessments and Joint Health and Wellbeing Strategies, Department of Health and Social Care

SOUTH TYNESIDE SPECIFIC LINKS

South Tyneside Joint Strategic Needs Assessment (JSNAA)

1. Introduction

Local authorities and Integrated Care Boards (ICBs) have equal and joint duties to prepare Joint Strategic Needs Assessments (JSNAs) and Joint Local Health and Wellbeing Strategies (JLHWSs), through the health and wellbeing board.

The purpose of the JSNA and JLHWS is to identify local needs to inform strategies and services to improve the health and wellbeing of the local community and reduce inequalities for all ages.

2. Joint Strategic Needs Assessment

A JSNA is an assessment of the current and future health and social care needs of the local community. These are needs that could be met by the local system and its partners, for example the local authority, Integrated Care Board, voluntary sector or the NHS.

The JSNA is produced by the local health and wellbeing board, and is unique to the local area. The health and wellbeing board should also consider a wide range of factors that impact on their communities’ health and wellbeing, and local assets that can help to improve outcomes and reduce inequalities. JSNAs should include information and outcomes for adult safeguarding. Each local area is free to undertake the JSNA in a way best suited to its local circumstances; there is no template or format that must be used and no mandatory data set to be included.

Within South Tyneside the approach taken includes asset within any assessment carried out and is therefore referred to as the JSNAA. The process of developing the key documents focuses on specific themes or topics rather than providing one overall needs assessment for South Tyneside. This approach enables individuals to access the relevant information more easily and allows documents to be updated more frequently as well as hosted on the website with a range of links to other supporting documents.

A range of quantitative (numeric) and qualitative (non-numeric) evidence should be used in the JSNA. There are a number of data sources and tools that the health and wellbeing board may find useful for obtaining quantitative data. Qualitative information can be gathered in a variety of ways, including views collected by the local Healthwatch organisation or by local voluntary sector organisations, feedback given to local providers by service users, and views fed in as part of community participation within the JSNA and JLHWS process.

3. Joint Local Health and Wellbeing Strategy

The JLHWS should turn the JSNA findings into clear outcomes that the health and wellbeing board wants to achieve, which will inform local commissioning, and the development of locally led initiatives that meet the outcomes agreed and the needs identified.

The JLHWS is the strategy for meeting the needs identified in the JSNA. As with JSNAs, it is produced by the health and wellbeing board, is unique to each local area, and there is no prescribed format.

However, the board must have regard to the integrated care strategy when preparing their joint local health and wellbeing strategies, as well as having regard to the NHS priorities and the statutory guidance.

The JLHWS should explain what priorities the health and wellbeing board has set in order to tackle the needs identified in the JSNA.

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RELEVANT CHAPTERS

Safer Recruitment and Employment

Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance

RELEVANT INFORMATION

DBS Checks for Adult Social Care Roles (Disclosure and Barring Service)

Check someone’s criminal record as an employer (gov.uk)

Criminal Record Support Service (Nacro)

1. Introduction

Employers need to make sure, to the best of their ability, that the people who they employ – as paid staff, volunteers or contractors – are committed to providing good quality care and support to adults, their carers and other family members, including children.

Carrying out robust criminal records checks is part of a number of safer recruitment measures which can help  prevent unsuitable people being employed to work with vulnerable groups.

As well as thorough recruitment processes, ongoing training, staff supervision and appraisal programmes are all important to ensuring safer working practices.

2. Disclosure and Barring Service

The Disclosure and Barring Service (DBS) helps employers make safer recruitment decisions. It is responsible for:

  • processing requests from organisations for criminal records checks (know as DBS checks) on individuals;
  • deciding whether it is right that a person should be put on, or removed from, a barred list;
  • placing or removing people from the DBS children’s barred list and adults’ barred list for England, Wales and Northern Ireland.

As well as processing requests and making decisions, the DBS maintains the adults’ and children’s Barred Lists (see Section 4, Barred Lists and Duty to Refer) which bar someone from working in a job that involves regulated activity.

3. Disclosure and Barring Service checks

The minimum age at which someone can be asked to apply for a criminal record check from the DBS is 16 years old.

Before an organisation requires a standard or enhanced check through the Disclosure and Barring Service, it is legally responsible for ensuring the job is eligible (see Eligibility, DBS).

The DBS eligibility tool can be used to determine what type of check a particular role could be eligible for:  Find out which DBS Check is Right for your Employee

3.1 Types of disclosures

There are four types of disclosure:

  • a basic check: which shows unspent convictions and conditional cautions.
  • a standard check: which shows spent and unspent convictions, cautions, reprimands and warnings;
  • an enhanced check: which shows the same as a standard check plus any information held by local police that’s considered relevant to the role;
  • an enhanced check with a check of the barred lists: which shows the same as an enhanced check plus whether the applicant is on the adults’ barred list, children’s barred list or both.

Under the Rehabilitation of Offenders Act 1974, many convictions or cautions become ‘spent’ after a specified length of time, known as the ‘rehabilitation period’. This means that once the rehabilitation period has been completed, they will not show on a basic DBS check. Applicants do not need to tell anyone about a spent conviction unless they are applying for a job where a standard, enhanced, or enhanced with barred lists DBS check is needed.

3.2 Adult first check

See Types of DBS checks and how to apply (DBS)

DBS adult first is a service available to organisations who can request a check of the DBS adults’ barred list. Depending on the result, a person can be permitted to start work, under supervision, with adults before a DBS certificate has been obtained.

There are strict criteria:

  • the role must require a criminal record check by law;
  •  it must be eligible for access to the DBS adults’ barred list;
  • the organisation must have requested a check of the DBS adults’ barred list on the DBS application form.

The DBS’ reply to an adult first check request will state either:

  • option 1: ‘Registered body must wait for the DBS certificate’; or
  • option 2: ‘no match exists for this person on the current adults’ barred list’

It will also state that it is only the first part of the criminal record check application process and that further information will follow.

f the adult first check indicates that the registered body must wait for the DBS certificate, it may indicate there is a match on the DBS adults’ barred list. However, further investigation will be required to confirm this and the organisation should wait to receive the certificate.

3.3 Update service

The DBS provides an online Update Service, to which staff or volunteers can subscribe and review annually for a small fee (free for volunteers). This helps them keep their DBS certificate up to date, so it can be taken with them from one job to another, as long as they remain within the same workforce (working with adults for example) unless:

  • an employer asks them to get a new certificate;
  • they need a certificate for a different type of ‘workforce’ (for example, they have an ‘adult workforce’ certificate and need a ‘child workforce’ certificate);
  • they need a different level of certificate (for example, they have a standard DBS certificate and need an enhanced one).

Employers can do immediate online checks of people who have registered with the update service. The update service is for standard and enhanced DBS checks only (see 3.1 Types of Disclosures).

A new DBS check will only be required if the update service check indicates there has been a change in the person’s status, due to new information added.

4. Barred Lists and Duty to Refer

There are two barred lists maintained by the Disclosure and Barring Service covering those who are:

  • barred from working with children;
  • barred with working with adults.

A person who is barred from working with children or adults commits a criminal offence if they work, volunteer or try to work or volunteer with the group from which they have been barred.

An organisation which knows they are employing someone who is barred to work with that particular group, will also be committing a criminal offence.

Legally an organisation must make a referral to the Disclosure and Barring Service if two conditions are met:

  • Condition 1 – permission for the person to engage in regulated activity with children and/or vulnerable adults is withdrawn. Or the person is moved to another area of work that isn’t regulated activity. This includes situations when this action would have been taken, but the person was re-deployed, resigned, retired, or left.
  • Condition 2- there are concerns the person has carried out one of the following:
    • engaged in relevant conduct in relation to children and / or adults. An action or inaction has harmed a child or vulnerable adult or put them at risk or harm or;
    • satisfied the harm test in relation to children and / or vulnerable adults. For example, there has been no relevant conduct but a risk of harm to a child or vulnerable still exists; or
    • been cautioned or convicted of a relevant (automatic barring either with or without the right to make representations) offence.

See the DBS referral flowchart.

5. Regulated Activity with Adults

See Regulated activity (adults) – Department of Health and Social Care

Regulated Activity is work which involves close and unsupervised contact with adults, and which cannot be undertaken by a person who is on the Disclosure and Barring Service’s Barred List for adults.

There are six categories of activity which fall within the definition of regulated activity (including anyone who provides day to day management or supervision of people carrying out these roles):

  • providing health care;
  • providing personal care (e.g. providing/training/instructing/or offering advice or guidance on physical assistance with eating or drinking, going to the toilet, washing or bathing, dressing, oral care or care of the skin, hair or nails because of an adult’s age, illness or disability; or prompting and supervising an adult to undertake such activities where necessary because of their age, illness or disability);
  • providing social work;
  • providing assistance with cash, bills and/or shopping;
  • providing assistance in the conduct of a person’s own affairs, e.g. by virtue of an enduring power of attorney;
  • conveying / transporting an adult (because of their age, illness or disability) either to or from their place of residence and a place where they have received, or will be receiving, health care, personal care or social care; or between places where they have received or will be receiving health care, personal care or social care. This will not include family and friends or taxi drivers.

There is a duty on a ‘regulated activity provider’ to find out whether a person is barred before allowing that person to carry out regulated activity tasks in their work.

It is a criminal offence for a person on one of the barred lists to carry out regulated activity tasks, or for an employer / voluntary organisation knowingly to employ a barred person in a regulated activity role.

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 RELEVANT INFORMATION

NHS Digital  – Adult Social Care Data Hub 

NHS Digital – Safeguarding Adults

ADASS / LGA – Making effective use of data and information to improve safety and quality in adult safeguarding

1. Introduction – Using Data to Improve Services

NHS Digital collect a range of data covering many aspects of adult health and social care. This includes data submitted by NHS trusts, local authorities, and providers.  Reports published by NHS Digital can be used to look at trends in adult social care and safeguarding adults activity at the national, regional and local level.

However, to measure the effectiveness of safeguarding adults practice locally, the Safeguarding Adults Board will also need to collect and analyse its own data. The Safeguarding Adult Board (SAB) is required under the Care Act 2014 to be able to share strategic information to improve local safeguarding practice.

Information which could be useful locally includes:

  • data on safeguarding notifications to increase the SAB’s understanding of how widespread abuse and neglect is and how this may change over time;
  • evidence of community awareness of adult abuse and neglect and how to respond.

The SAB annual report will also provide a summary of safeguarding adults activity in the local area and outline how it is meeting the aims of its business plan / strategic plan.

2. Safeguarding Adults Collection

Each year NHS Digital publishes the findings from data collected from local authorities under the Safeguarding Adults Collection (SAC).

The reports published provide details of safeguarding activity relating to adults aged 18 and over in England.

Data collected covers the following:

  • number of safeguarding concerns;
  • number of section 42 enquiries;
  • types of risk;
  • risk assessment and outcomes;
  • making safeguarding personal;
  • safeguarding adult reviews.

This data can be used by safeguarding adult partners to:

  • understand trends in safeguarding concerns raised and enquiries conducted;
  • analyse the profile of people involved in safeguarding enquiries, and the nature of the risk of abuse or neglect involved;
  • supplement local data collected in relation to safeguarding practice and outcomes.

For more information see NHS Digital.

3. Deprivation of Liberty Safeguards

NHS Digital also collects a statutory annual return for Deprivation of Liberty Safeguards (DoLs).

Data collected from local authorities covers the following:

  1. the number of DoLS application requests made;
  2. the number of authorisation requests granted;
  3. the number of authorisation requests not granted;
  4. time taken to process DoLS applications.

See also  Deprivation of Liberty Safeguards (DoLS), under the Mental Capacity Act 2005 .

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CARE ACT 2014

The Act introduced duties on the Care Quality Commission to assess financial sustainability of the most difficult to replace providers, and support local authorities to ensure continuity of care if providers fail. There is a general duty for the local authority to promote diversity and quality in the market of local care and support providers. It must ensure a range of providers available; shaped by demands of individuals, families and carers; services are of high quality and meet needs and preferences of those wanting to access services.

RELEVANT CHAPTER

Promoting Wellbeing

RELEVANT INFORMATION

Chapter 4, Market Shaping and Commissioning of Adult Care and Support, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Introduction

High quality, personalised care and support can only be achieved where there is a vibrant, responsive market of service providers. The role of the local authority is critical to achieving this, both through the actions it takes to commission services directly to meet needs and the broader understanding of and interactions it undertakes with, the wider market, for the benefit of all local people and communities.

The Care Act 2014 places duties on local authorities to promote the efficient and effective operation of the market for adult care and support as a whole. This can be considered a duty to facilitate the market, in the sense of using a wide range of approaches to encourage and shape it, so that it meets the needs of all people in their area who need care and support, whether arranged or funded by the state, by the individual themselves, or in other ways. The ambition is for local authorities to influence and drive the pace of change for their whole market, leading to a sustainable and diverse range of care and support providers, continuously improving quality and choice, and delivering better, innovative and cost effective outcomes that promote the wellbeing of people who need care and support.

The market for care and support services is part of a wider system in which much of the need for care and support is met by people’s own efforts, by their families, friends or other carers, and by community networks. Local authorities have a vital role in ensuring that universal services are available to the whole population and where necessary, tailored to meet the needs of those with additional support requirements (for example housing and leisure services). Market shaping and commissioning should aim to promote a market for care and support that should be seen as broadening, supplementing and supporting all these vital sources of care and support.

Local authorities should review the way they commission services, as this is a prime way to achieve effective market shaping and directly affects services for those whose needs are met by the local authority, including where funded wholly or partly by the state.

At a time of increasing pressure on public funds, changing patterns of needs, and increasing aspirations of citizens, together with momentum for integrated services, joint commissioning, and choice for individuals, it is suggested that fundamental changes to the way care and support services are arranged may be needed, driven through a transformation of the way services are led, considered and arranged. Commissioning and market shaping are key levers for local authorities in designing and facilitating a healthy market of quality services.

2. Definitions

2.1 Market shaping

Market shaping means the local authority collaborating closely with other relevant partners, including people with care and support needs, carers and families, to facilitate the whole market in its area for care, support and related services.

This includes:

  • services arranged and paid for by the state through the authority itself;
  • those services paid by the state through direct payments;
  • those services arranged and paid for by individuals from whatever sources (self-funders);
  • services paid for by a combination of these sources.

Market shaping activity should stimulate a diverse range of appropriate high quality services (both in terms of the types, volumes and quality of services and the types of provider organisation), and ensure the market as a whole remains vibrant and sustainable.

The core activities of market shaping are to engage with stakeholders to develop understanding of supply and demand to understand likely trends that reflect people’s needs and aspirations. It should be based on evidence, to signal to the market the types of services needed now and in the future to meet them, encourage innovation, investment and continuous improvement.

It includes working to ensure that those who purchase their own services are empowered to be effective consumers, for example by helping people who want to take direct payments make informed decisions about employing personal assistants. A local authority’s own commissioning practices are likely to have a significant influence on the market to achieve the desired outcomes, but other interventions may be needed, for example, incentivising innovation by user-led or third sector providers, possibly through grant funding.

2.2 Commissioning

Commissioning is the local authority’s cyclical activity to assess the needs of its local population for care and support services, determining what element of this needs to be arranged by the authority, then designing, delivering, monitoring and evaluating those services to ensure appropriate outcomes. Commissioning has come to be shaped more by the outcomes commissioners and individuals identify, rather than volumes of activity expected and commissioners have sought to facilitate flexible arrangements with providers for other forms of service to support choice and control, such as Individual Service Funds (ISFs).

2.3 Procurement

Procurement is the specific functions carried out by the local authority to buy or acquire the services the local authority has a duty to arrange to meet people’s needs, to agreed standards to provide value for money to the public purse and deliver its commissioning strategy.

2.4 Contracting

Contracting is the means by which that process is made legally binding. Contract management is the process that ensures that the services continue to be delivered to the agreed quality standards. Commissioning encompasses procurement but includes the wider set of strategic activities.

Market shaping, commissioning, procurement and contracting are inter-related activities and the themes of the Care and Support Statutory Guidance apply to each to a greater or lesser extent depending on the specific activity.

3. Principles of Market Shaping and Commissioning

3.1 Focusing on outcomes

The local authority must ensure the promotion of the wellbeing of individuals who need care and support, and the wellbeing of carers. The outcomes they require, are central to all care and support functions in relation to individuals, emphasising the importance of enabling people to stay independent for as long as possible. See the chapters on Promoting Wellbeing and Preventing, Reducing and Delaying Needs.

The local authority will need to understand the outcomes which matter most to people in its area, and demonstrate that these outcomes are at the heart of its local strategies and approaches.

The local authority should consider the Measures from the Adult Social Care Outcomes Framework in addition to any locally collected information on outcomes and experiences, when framing outcomes for its locality and groups of people with care and support needs. The local authority should have regard to guidance from the Think Local Act Personal (TLAP) Partnership when framing outcomes for individuals, groups and their local population. In particular Making It Real which sets out what good personalised care and support should look like from the perspective of people with care and support needs, carers and family members.

Outcomes should be considered both in terms of outcomes for individuals and outcomes for groups of people and populations. Local authorities should consider the Care Quality Commission standards for quality and any emerging national frameworks for defining outcomes.

Local authorities should consider analysing and presenting local needs for services in terms of outcomes required. Local authorities should ensure that achieving better outcomes is central to its commissioning strategy and practices, and should be able to demonstrate that they are moving to contracting in a way that has an outcome basis at its heart. Local authorities should consider emerging best practice on outcomes based commissioning.

Outcomes based services are service arrangements that are defined on the basis of an agreed set of outcomes; either for an individual or a group of people. Moving more to an outcomes-based approach therefore means changing the way services are bought: from units of provision to meet a specified need (for example, hours of care provided) to what is required to ensure specified measurable outcomes for people are met.

The approach should emphasise:

  • prevention;
  • enablement;
  • ways of reducing loneliness and social isolation;
  • promotion of independence as ways of achieving and exceeding desired outcomes;
  • choice in how people’s needs are met.

Moving to an outcomes based approach will need to recognise that some outcomes are challenging to assess and local authorities may wish to consider involving service providers when considering how service evaluations can be interpreted.

In encouraging outcomes based services, consideration should be given to how services are paid for. The local authority should consider incorporating elements of ‘payments by outcomes’ mechanisms, where practical, to emphasise and embed this commissioning approach which is based on specifying the outcomes to be achieved, rather than the service outputs to be delivered. Whilst payments by outcomes may be theoretically the most appropriate approach for outcomes based services, it is recognised that proxies for outcomes may be required to make the approach practical. For example, an outcome an authority may wish to measure might be someone’s personal outcome ‘I want to maintain a nutritious and balanced diet’, but a proxy measure that is observable, attributable and capable of being described, may be the person receiving help with meal preparation at agreed and specified times. Care logs documenting punctual assistance in meal preparation, in conjunction with positive feedback from the person receiving care about support received might be used as part of the basis of payment.  It is also recognised that whilst these mechanisms are more commonplace in other types of commissioning, they are in their infancy for adult social care.

The design of any mechanism should, however, be introduced in cooperation with stakeholders and partners to ensure it is sustainable and ensure that innovation, and individual choice and control are not undermined. Any move to payments by outcomes should be achieved such that smaller, specialist, voluntary sector and community-based providers are not excluded from markets or disadvantaged, because for example, they do not have appropriate IT systems.

The Care Act outlines local authorities’ role in preventing, reducing or delaying the need for care and support. This includes how the authority facilitates and commissions services and how it works with other local organisations to build community capital and make the most of the skills and resources already available in the area. Local authorities should consider working not just with traditional public sector partners like health, but also with a range of other partners to engage with communities to understand how to prevent problems from arising.

3.2 Promoting quality

The local authority must facilitate markets that offer a diverse range of high quality and appropriate services. In doing so, they must have regard to ensuring the continuous improvement of those services and encouraging a workforce which effectively underpins the market through:

The quality of services provided and the workforce providing them can have a significant effect on the wellbeing of people receiving care and support, and that of carers, and it is important to establish agreed understandable and clear criteria for quality and to ensure they are met (see also Promoting Wellbeing chapter).

When considering the quality of services, the local authority should be mindful of:

  • capacity;
  • capability;
  • timeliness;
  • continuity;
  • reliability;
  • flexibility;
  • wellbeing,

Where appropriate, using the definitions that underpin the CQC’s Fundamental Standards of Care as a minimum, and having regard to the ASCOF framework of population outcomes.

High quality services should enable people who need care and support, and carers, to meet appropriate personal outcome measures, for example, a domiciliary care service which provides care two days a week so that a carer who normally provides care can go to work, is not a quality service if it is not available on the specified days, or the care workers do not arrive in time to allow the carer to get to work on time.

Local authorities should also consider other relevant national standards including those that are aspirational, for example, any developed by the National Institute of Health and Care Excellence (NICE).

It should encourage a wide range of service provision to ensure that people have a choice of appropriate services; appropriateness is a fundamental part of quality. Appropriate services will meet people’s needs and reasonable preferences.

When arranging services itself, the local authority must ensure its commissioning practices and the services delivered on its behalf comply with the requirements of the Equality Act 2010, and do not discriminate against people with protected characteristics; this should include monitoring delivery against the requirements of that Act. When shaping markets for services, it should work to ensure compliance with this Act for services provided in their area that it does not arrange or pay for. Local authorities should consider care and support services for their appropriateness for people from different communities, cultures and beliefs.

The local authority should encourage services that respond to the fluctuations and changes in people’s care and support needs, for example someone with fluctuating mobility or visual impairment. It should support the transition of services throughout the stages of people with care and support needs’ lives to ensure the services provided remain appropriate. This is particularly important, for example, for young people with care and support needs and young carers transitioning to adulthood (see Transition to Adult Care and Support chapter.

The local authority should commission services having regard to the cost-effectiveness and value for money that the services offer for public funds. See the Local Government Association Adult Social Care Efficiency Programme.

People working in the care sector play a central role in providing high quality services. The local authority must consider how to help foster, enhance and appropriately incentivise this vital workforce to underpin effective, high quality services. In particular, it should consider how to encourage training and development for the workforce, including for the management of care services, though, for example, national standards recommended by Skills for Care:

and have regard to funding available through grants to support the training of care workers in the independent sector.

The local authority should consider encouraging the training and development of care worker staff to at least the standard of the Care Certificate being developed by Skills for Care and Skills for Health.

When commissioning services, the local authority should assure itself and have evidence that service providers employ staff who are remunerated to a level that enables them to retain an effective workforce. Remuneration must be at least sufficient to comply with the national minimum wage legislation for hourly pay or equivalent salary. This will include appropriate remuneration for any time spent travelling between appointments. Guidance on these issues can be found at the HMRC website.

When commissioning services, the local authority should assure itself and have evidence that contract terms, conditions and fee levels for care and support services are appropriate to provide the delivery of the agreed care packages with agreed quality of care. This should support and promote the wellbeing of people who receive care and support, and allow for the service provider ability to meet statutory obligations to pay at least the national minimum wage and provide effective training and development of staff and enable retention of staff. It should also allow retention of staff commensurate with delivering services to the agreed quality, and encourage innovation and improvement. Local authorities should have regard to guidance on minimum fee levels necessary to provide this assurance, taking account of the local economic environment. This assurance should understand that reasonable fee levels allow for a reasonable rate of return by independent providers that is sufficient to allow the overall pool of efficient providers to remain sustainable in the long term. The following tools may be helpful as examples of possible approaches:

The local authority should also ensure that it has functions and systems in place to fulfil its duties on market shaping and commissioning itself that are fit for purpose, with sufficient capacity and capability of trained and qualified staff to meet the requirements set out in the Care Act 2014 and the Care and Support Statutory Guidance.

3.3 Supporting sustainability

The local authority must work to develop markets for care and support that – whilst recognising that individual providers may exit the market from time to time – ensure the overall provision of services remains healthy in terms of the sufficiency of adequate provision of high quality care and support needed to meet expected needs. This will ensure there are a range of appropriate and high quality providers and services from which people can choose.

The local authority should understand the business environment of providers offering services in its area and seek to work with those facing challenges and understand their risks. Where needed, based on expected trends, the local authority should consider encouraging service providers to adjust the extent and types of service provision. This could include signalling to the market as a whole the possible need to extend or expand services, encourage new entrants to the market in the area, or if appropriate, signal likely decrease in needs – for example, drawing attention to a possible reduction in home care needs, and changes in demand resulting from increasing uptake of direct payments. The process of developing and articulating a Market Position Statement or equivalent should be central to this process.

The local authority should consider the impact of its own activities on the market as a whole, in particular the potential impact of its commissioning and re-commissioning decisions, how services are packaged or combined for tendering, and where they may also be a supplier of care and support. The local authority may be the most significant purchaser of care and support in an area, and therefore its approach to commissioning will have an impact beyond those services which it contracts. It must not undertake any actions which may threaten the sustainability of the local market as a whole, for example, by setting fee levels below an amount which is not sustainable for providers in the long term.

The local authority should have effective communications and relationships with providers in its area that should minimise risks of unexpected closures and failures. It should have effective interaction and communication with the Care Quality Commission (CQC) about the larger and most difficult to replace providers for which the CQC will provide financial oversight. It should review the intelligence it has about the sustainability of care providers drawn from market shaping, commissioning and contract management activities.

Where the authority believes there is a significant risk to a provider’s financial viability, and where they consider it would be in the best interests of service users, the authority should consider what assistance may be provided or brokered to help the provider return to viability, and consider what actions might be needed were that provider to fail. For example, where a local authority has arranged services for people with a provider that appears to be at risk, it should undertake early planning to identify potential replacement service capacity. Where it is apparent to a local authority that a provider is likely to imminently fail financially, either through its own intelligence or through information from the CQC, the authority should prepare to step in to ensure continuity of care and support for people who have their care and support provided by that provider.

3.4 Ensuring choice

The local authority must encourage a variety of different providers and different types of services. This is important in order to facilitate an effective open market, driving quality and cost-effectiveness so as to provide genuine choice to meet the range of needs and reasonable preferences of local people who need care and support services, including for people who choose to take direct payments, recognising, for example, the challenges presented in remote rural areas for low volume local services.

It must encourage a range of different types of service provider organisations to ensure people have a genuine choice of different types of service. This will include independent private providers, third sector, voluntary and community based organisations, including user-led organisations, mutual and small businesses. Local authorities should note that the involvement of people with specific lived experience of the type of needs being met, may lead to better outcomes for people who use services and carers as they directly empathise with service users. This should recognise that the different underpinning philosophies, cultural sensitivity and style of service of these organisations may be more suited to some people with care and support needs. The local authority should consider encouraging and supporting providers or taking other steps to promote an appropriate balance of provision between types of provider, having regard to competition rules and the need for fairness and legal requirements for all potential providers who may wish to compete for contracts.

When commissioning services to meet people’s eligible needs, where a local authority develops approved lists and frameworks that are used to limit the number of providers they work with, for example within a specific geographical area or for a particular service type to achieve strategic partnerships and value for money, the local authority must consider how to ensure that there is still a reasonable choice for people who need care and support.

It should encourage a genuine choice of service type, not only a selection of providers offering similar services, encouraging, for example, a variety of different living options such as shared lives, extra care housing, supported living, support provided at home, and live-in domiciliary care as alternatives to homes care, and low volume and specialist services for people with less common needs.

Choice for people who need care and support and carers should be interpreted widely. The local authority should encourage choice over the way services are delivered, for example:

  • developing arrangements so that care can be shared between an unpaid carer or relative and a paid care worker;
  • choice over when a service is delivered;
  • choice over who is a person’s key care worker;
  • arranging for providers to collaborate to ensure the right provision is available, for example, a private provider and a voluntary organisation working together;
  • choice over when a service is delivered.

The local authority must have regard to ensuring a sufficiency of provision – in terms of both capacity and capability – to meet anticipated needs for all people in its area needing care and support – regardless of how they are funded. This will include regularly reviewing trends in needs including multiple and complex needs, outcomes sought and achieved, and trends in supply, anticipating the effects and trends in prevention and community-based assets, and through understanding and encouraging changes in the supply of services and providers’ business and investment decisions.

When considering the sufficiency and diversity of service provision, it should consider all types of service that are required to provide care and support for the local authority’s whole population, including for example:

  • support services and universal and community services that promote prevention;
  • domiciliary (home) care;
  • homes and other types of accommodation care;
  • nursing care;
  • live-in care services;
  • specialist care;
  • support for carers;
  • reablement services;
  • sheltered accommodation and supported living;
  • shared lives services;
  • other housing options;
  • community support;
  • counselling;
  • social work;
  • information, brokerage, advocacy and advice services;
  • direct payment support organisations.

This will include keeping up to date with innovations and developments in services, networking through for example, the Association of Directors of Adult Social Services (ADASS), Think Local Act Personal (TLAP) and the Local Government Association (LGA).

The local authority should facilitate the personalisation of care and support services, encouraging services (including small, local, specialised and personal assistant services that are highly tailored), to enable people to make meaningful choices and to take control of their support arrangements, regardless of service setting or how their personal budget is managed. Local authorities should have regard to the TLAP Partnership agreement that sets out how shaping markets to meet people’s needs and aspirations, including housing options, can promote choice and control. Alongside the suitability of living accommodation, the local authority should consider how it can encourage the development of accommodation options that can support choice and control and promote wellbeing. Personalised care and support services should be flexible so as to ensure people have choices over what they are supported with, when and how their support is provided and wherever possible, by whom. The mechanism of Individual Service Funds by service providers, which are applicable in many different service types, can help to secure these kinds of flexibilities for people and providers.

The local authority should help people who fund their own services or receive direct payments, to ‘micro-commission’ care and support services and / or to pool their budgets, and should ensure a supporting infrastructure is available to help with these activities. Many local authorities, for example, are utilising web based systems such as e-Marketplaces for people who are funding their own care or are receiving direct payments to be able to search for, consider and buy care and support services online, or consider joint purchases with others. This often involves offering information and advice about, for example, the costs and quality of services and information to support safeguarding (see also Information and Advice chapter). This should include facilitating organisations that support people with direct payments and those whose care is funded independently from the local authority to become more informed and effective consumers and to overcome potential barriers such as help to recruit and employ personal assistants and to assist in overcoming problems and issues. This activity should help to match people’s wider needs with services.

Local authorities must facilitate information and advice to support people’s choices for care and support. This should include where appropriate through services to help people with care and support needs understand and access the systems and processes involved and to make effective choices. This is a key aspect of the duty to establish and maintain a universal information and advice service locally. Information and advice services should be reviewed for effectiveness using people’s experiences and feedback. This feedback forms part of the overall information a local authority considers about people’s needs and aspirations.

The local authority should facilitate local markets to encourage a sufficiency of preventative, enablement and support services, including support for carers to make caring more sustainable, such as interpreters, signers and communicator guides, and other support services such as telecare, home maintenance and gardening that may assist people achieve more independence and supports the outcomes they want.

The local authority should encourage flexible services to be developed and made available that support people who need care and support, and carers who need support, to take part in work, education or training. Services should be encouraged that allow carers who live in one local authority area but care for someone in another local authority area to access services easily, bearing in mind guidance on ordinary residence.

3.5 Co-production with stakeholders

Local authorities should pursue the principle that market shaping and commissioning should be shared endeavours, with commissioners working alongside people with care and support needs, carers, family members, care providers, representatives of care workers, relevant voluntary, user and other support organisations and the public to find shared and agreed solutions (see also the TLAP guidance on co-production).

3.6 Developing local strategies

Commissioning and market shaping should be fundamental means for local authorities to facilitate effective services in their area and it is important that authorities develop evidence-based local strategies for how they exercise these functions, and align these with wider corporate planning.  It should publish strategies that include plans that show how its legislative duties, corporate plans, analysis of local needs and requirements (integrated with the Joint Strategic Needs Assessment and Joint Local Health and Wellbeing Strategy), thorough engagement with people, carers and families, market and supply analysis, market structuring and interventions, resource allocations and procurement and contract management activities translate (now and in future) into appropriate high quality services that deliver identified outcomes for the people in their area and address any identified gaps.

Market shaping and commissioning intentions should be cross-referenced to the JSNA, and should be informed by an understanding of the needs and aspirations of the population and how services will adapt to meet them. Strategies should be informed and emphasise preventative services that encourage independence and wellbeing, delaying or preventing the need for acute interventions (see also Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies chapter).

Market shaping and commissioning should become an integral part of understanding and delivering the whole health and care economy, and reflect the range and diversity of communities and people with specific needs, in particular:

  • people needing care and support themselves (through for example, consumer research);
  • carers;
  • carer support organisations;
  • health professionals;
  • care and support managers and social workers (and representative organisations for these groups);
  • relevant voluntary, user and other support organisations;
  • independent advocates;
  • wider citizens;
  • provider organisations (including where appropriate housing providers); and
  • other tiers of local government.

A co-produced approach will stress the value of meaningful engagement with people at all stages, through design, delivery and evaluation, rather than simply as ‘feedback’. The local authority should publish and make available its local strategies for market shaping and commissioning, giving an indication of timescales, milestones and frequency of activities, to support local accountability and engagement with the provider market and the public.

The local authority can best start implementing its statutory responsibilities in relation to market shaping and commissioning and provider failure by developing with providers and stakeholders a published Market Position Statement. It may be helpful for Market Position Statements from neighbouring local authority areas to be coordinated to ensure a degree of consistency for people who will use the documents; this is particularly true for urban areas.

The local authority should review strategies related to care and support together with stakeholders to ensure they remain fit for purpose, learn lessons, and adapt to incorporate emerging best practice, noting that peer review has a strong track record in driving improvement. It is suggested that reporting against strategies for care and support should form part of the local authority’s Local Account.

Many public sector bodies, including local authorities, have radically transformed services by reconsidering commissioning in a strategic context. The Government’s Commissioning Academy is working to promote such transformational approaches and local authorities should have regard to the emerging best practice it is producing.

Developing a diverse market in care and support services can boost employment and create opportunities for local economic growth, through for example, increasing employment opportunities for working age people receiving care and carers, and developing the capacity of the care workforce. Local authorities should consider how their strategies related to care and support can be embedded in wider local growth strategies, for example, engaging care providers in local enterprise partnerships.

The local authority should have regard to best practice on efficiency and value for money.

The local authority strategies should adhere to general standards, relevant laws and guidance, including the Committee on Standards in Public Life principles of accountability, regularity and ensuring value for money alongside quality, and the HM Treasury guidance on Managing Public Money.

The local authority should develop standards on transparency and accountability to ensure citizens are able to contribute to and understand policy and review delivery. Standards should be in line with the codes of practice drawn up by the Ministry of Housing Communities & Local Government.

Local authorities should take the lead to engage with a wide range of stakeholders and citizens in order to develop effective approaches to care and support, including through developing the JSNA and a Market Position Statement. While the duties under the Care Act fall upon local authorities, successful market shaping is a shared endeavour that requires a range of coordinated action by commissioners and providers, working together with the citizen at the centre.  Local authorities should engage and cooperate with stakeholders to reflect the range and diversity of communities and people with specific needs, for example:

  • people needing care and support themselves and their representative organisations;
  • carers and their representative organisations;
  • health professionals;
  • social care managers and social workers;
  • independent advocates;
  • support organisations that help people who need care consider choices (including financial options);
  • provider organisations (including where appropriate housing providers and registered social landlords);
  • wider citizens and communities including individuals and groups who are less frequently heard (for example, LGBT communities where there may be a lack of data on care and support needs and preferences) or at risk from exclusion, including those who have communication issues and involving representatives of those who lack mental capacity.

Engagement with people needing care and support, people likely to need care and support, carers, independent advocates, families and friends, should emphasise understanding the needs of individuals and specific communities, what aspirations people have, what outcomes they would like to achieve, their views on existing services and how they would like services to be delivered in the future. It should also seek to identify the types of support and resources or facilities available in the local community which may be relevant for meeting care and support needs, to help understand and build community capacity to reinforce the more formal, regulated provider market. In determining an approach to engagement, local authorities should consider methods that enable people to contribute meaningfully to:

  • setting the strategic direction for market shaping and commissioning;
  • engaging in planning – using methods that support people to identify problems and solutions, rather than relying on ‘downstream’ consultation;
  • identifying outcomes and set priorities for specific services;
  • setting measures of success and monitor ongoing service delivery, including through the experience of people who use services and carers;
  • playing a leading role throughout tendering and procurement processes, from developing specifications to evaluating bids and selecting preferred providers;
  • contributing to reviews of services and strategies that relate to decommissioning decisions and areas for new investment;
  • managing any changes to service delivery, recognising that long-term relationships may have developed in the community and with individual people receiving care and support and carers.

Engagement with service providers should emphasise understanding the organisation’s strategies, risks, plans, and encourage building trusting relationships and fostering improvement and innovation to better meet the needs of people in the area. The local authority should consider engagement with significant suppliers of services to provider organisations, where this would help improve its understanding of markets, for example, engaging with employment and training services that might enable local authorities to gain access to frontline insights on care provision and the local workforce supply and training.

The local authority should ensure that active engagement and consultation with local people is built into the development and review of their strategies for market shaping and commissioning, and is demonstrated to support local accountability (for example, via the Local Account).

The local authority should make available to providers available routes to register concerns or complaints about engagement and commissioning activities. Local authorities should consider the adequacy and effectiveness of these routes and processes as part of their engagement and trust building activities.

4. Undertaking Market Shaping and Commissioning

4.1 Understanding the market

The local authority must understand local markets and develop knowledge of current and future needs for care and support services, and, insofar as they are willing to share and discuss, understand providers’ business models and plans. This is important so that the authority can articulate likely trends in needs and signal to the market the likely future demand for different types of services for its market as a whole, and understand the local business environment, to support effective commissioning. Activities to understand the market should appropriately reflect an authority’s strategic plans for integrating health, social care and related services and will require the cooperation of those other parties, as well as other authorities in the region, to ensure a complete picture.

The local authority (through an engagement process, in concert with commissioners for other services where appropriate) should understand and articulate the characteristics of current and future needs for services. This should include reference to underpinning demographics, drivers and trends, the aspirations, priorities and preferences of those who will need care and support, their families and carers, and the changing care and support needs of people as they progress through their lives. This should include an understanding of:

  • people with existing care needs drawn from assessment records;
  • carers with existing care needs drawn from carers’ assessment records;
  • new care and support needs;
  • those whose care and support needs will transition from young people’s services to adult services;
  • those transitioning from working-age adults to services for older people;
  • people whose care and support needs may fluctuate;
  • people moving to higher needs and specialised care and support; and
  • those that will no longer need care and support.

It should include information and analysis of low incidence needs and multiple and complex conditions, as well as more common conditions such as sensory loss. It should also include information about likely changes in requirements for specialist housing required by people with care and support needs. See also the online tool shop@, Housing Learning and Improvement Network.

The local authority should have in place robust methods to collect, analyse and extrapolate this information about care and support needs, including as appropriate information about specific conditions (for example, neurological conditions such as Stroke, Parkinson’s, Motor Neurone Disease), and multiple and complex needs. This should sit alongside information about providers’ intentions to deliver support over an appropriate timescale – likely to be at least five years hence, with alignment to other strategic time frames. Data collection should include information on the quality of services provided in order to support local authority duties to foster continuous improvement. This could be achieved, for example, by collecting and acting on feedback from people who receive care, their families and carers alongside information on the specific nature of the services people receive (e.g. regularity and length of homecare visits). This will allow for an assessment of correlation between customer experience and service provision. Data collection must be sufficient to allow local authorities to meet their duties under the Equality Act 2010.

The local authority should include in its engagement and analysis services and support provided by voluntary, community services, supported housing providers, and other groups that make up ‘community assets’ and plan strategically to encourage, make best use of and grow these essential activities to integrate them with formal care and support services.

The local authority should also seek to understand trends and changes to the levels of support that are provided by carers, and seek to develop support to meet its needs, noting that amongst other sources, census data include information on carers and their economic activity. It should understand the trends and likely changes to the needs of carers in employment, so as to better plan future support.

In order to understand future trends in needs and demands, the local authority should include an understanding of people who are or are likely to be both wholly or partly state funded, and people who are or are likely to be self-funding. It should also include an analysis of those self-funders who are likely to move to state funding in the future.

The understanding of needs should also include an understanding of the likely demand for state funded services that the local authority will need to commission directly, and state funded services likely to be provided through direct payments and require individuals to ‘micro-commission’ services. The local authority should also consider the extent to which people receiving services funded by the state may wish to ‘top up’ their provision to receive extra services or premium services; that is, the assessment of likely demand should be for services that people are likely to need and be prepared to pay for through top ups.

The assessment of needs should be integrated with the process of developing, refining and articulating a local authority’s Joint Strategic Needs Assessment. Where appropriate, needs should be articulated on an outcomes basis.

In order to gather the necessary information to shape its market, the local authority should engage with providers (including the local authority itself if it directly provides services) to seek to understand and model current and future levels of service provision supply, the potential for change in supply, and opportunities for change in the types of services provided and innovation possible to deliver better quality services and greater value for money. It should understand the characteristics of providers’ businesses, their business models, market concentration, investment plans etc. Information about both supply and expected demand for services should be made available publicly to help facilitate the market and empower communities and citizens when considering care and support. Smaller care providers should be included in engagement. Local authorities may find helpful the guidance Market Shaping Tool: Supporting Local Authority and SME Care Provider Innovation and Collaboration that was co-produced by the Department of Health with ADASS and LGA, provider organisations and people with lived experience.

Assessment of supply and potential demand should include an awareness and understanding of current and future service provision and potential demand from outside the local authority area where this is appropriate, for example in considering services to meet highly specialised and complex needs, care and support may not be available in the local authority area, but only from a small number of specialised providers in the country. Consideration should be given to whether such services might better be commissioned and facilitated regionally.

4.2 Facilitating the development of the market

The local authority should collaborate with stakeholders and providers to bring together information about needs and demands for care and support with that about future supply, to understand for their whole market the implications for service delivery. This will include understanding and signalling to the market as a whole the need for the market to change to meet expected trends in needs, adapt to enhance diversity, choice, stability and sustainability, and consider geographic challenges for particular areas. To this picture, the local authority should add their own commissioning strategy and future likely resourcing for people receiving state funding. The local authority should consider coordinating these market shaping and related activities with other neighbouring authorities where this would provide better outcomes.

The local authority should consider how to support and empower effective purchasing decisions by people who self-fund care or purchase services through direct payments, recognising that this can help deliver a more effective and responsive local market.

It should ensure that the market has sufficient signals, intelligence and understanding to react effectively and meet demand, a process often referred to as market structuring or signalling. The local authority should publish, be transparent and engage with providers and stakeholders about the needs and supply analysis to assist this signalling. It is suggested that this is best achieved through the production and regular updating of a document like a Market Position Statement that clearly provides evidence and analysis and states the local authority’s intent. A Market Position Statement is intended to encourage a continuing dialogue between a local authority, stakeholders and providers, where that dialogue results in an enhanced understanding by all parties is an important element of signalling to the market.

A Market Position Statement should contain information on: the local authority’s direction of travel and policy intent, key information and statistics on needs, demand and trends, (including for specialised services, personalisation, integration, housing, community services, information services and advocacy, and carers’ services), information from consumer research and other sources about people’s needs and wants, information to put the authority’s needs in a national context, an indication of current and future authority resourcing and financial forecasts, a summary of supply and demand, the authority’s ambitions for quality improvements and new types of services and innovations, and details or cross-references to the local authority’s own commissioning intentions, strategies and practices.

Developing and publishing a Market Position Statement is one way a local authority can meet its duties to make available information about the local market, and demonstrate activity to meet other parts of the Care Act 2014. Market Position Statements for care and support services should combine, cross refer or otherwise complement other similar statements for related services, particularly where there is an integrated approach or ambition, for example, housing.

As part of developing and publishing a document like a Market Position Statement, the local authority should engage with stakeholders and partners to structure their markets. This could include:

  • discussions with potential providers;
  • actively promoting best practice and models of care and support;
  • understanding the business planning cycles of providers;
  • aligning interactions and supporting the provider’s business planning;
  • identifying and addressing barriers to market entry for new providers;
  • facilitating entry to the market through advice and information;
  • streamlining the authority’s own procurement processes;
  • promoting diversification of provider organisations;
  • working with providers on an ‘open-book accounting’ approach to cost current and future services and ensure provider sustainability;
  • supporting providers through wider local authority activity – planning, business support and regeneration.

The local authority may consider that market structuring activity – signalling to the market and providing assistance – is not achieving the strategic aims as quickly or as effectively as needed, and may wish to consider more direct interventions in the market. Market interventions may also be planned as part of the market shaping and commissioning strategies where there is an immediate need for intervention.

Market interventions could for example include: refocusing local authority business support initiatives onto the care and support sector, exploring how local care and support projects could attract capital investments and support and what guarantees may be needed, encouraging and supporting social enterprises, micro-enterprises, Community Interest Companies, and User Led Organisations (for example, incentivising innovation by third sector providers, possibly through grant funding), exploring planning barriers and using planning law, offering access to training and development opportunities.

The local authority should consider monitoring progress toward the ambitions set out in the Market Position Statement, and making the progress public along with information about its own commissioning decisions, as part of a commitment to transparency and accountability. This would demonstrate that the authority’s commissioning activity is in line with the ambition and direction of travel articulated in its Market Position Statement, and might be achieved by including this information in regular updates to the Market Position Statement.

4.3 Promoting integration with local partners

The Health and Social Care Act 2012 sets out specific obligations for the health system and its relationship with care and support services. It gives a duty to NHS England, Integrated Care Boards and Health and Wellbeing Boards to make it easier for health and social care services to work together to improve outcomes for people. The local authority has a corresponding duty to carry out their care and support functions with the aim of integrating services with those provided by the NHS or other health-related services, such as housing.

It should also consider working with appropriate partners to develop integration with services related to care and support such as housing, employment services, transport, benefits and leisure services. Local authorities should prioritise integration activity in areas where there is evidence that effective integration of services materially improves people’s wellbeing, for example, end of life care, and should take account of the key national and local priorities and objectives of the Better Care Fund, for example, stopping people reaching crisis and reducing the emergency admissions to hospitals.

Integrated services built around an individual’s needs are often best delivered in the home. The suitability of living accommodation is a core component of an individual’s wellbeing and when developing integrated services, the local authority should consider the central role of housing within integration, with associated formal arrangements with housing and other partner organisations.

The local authority should work towards providing integrated care and support, providing services that work together to provide better outcomes for individuals who need care and support and enhancing their wellbeing, noting that this will require the sharing of information about current and future needs and likely service provider’s responses to underpin a holistic approach to developing integrated care and support pathways. See also Integration, Cooperation and Partnerships chapter.

The local authority should consider with partners the enabling activities, functions and processes that may facilitate effective integrated services. These will include consideration of: joint commissioning strategies, joint funding, pooled budgets, lead commissioning, collaborative commissioning, working with potential service providers to consider innovative ways of arranging and delivering services, and making connections to public health improvement.

4.4 Securing supply in the market and assuring its quality and value for money through contracting

Local authorities should consider best practice on commissioning services, for example the National Audit Office guidance Value for Money to ensure they deliver quality services with value for money. This means optimal use of resources to achieve intended outcomes, and must reference the quality of service delivered and the outcomes achieved for people’s wellbeing, and should not be solely based on achieving the lowest cost. Achieving value for money may mean arranging service provision collaboratively with other authorities, in order to secure viable, quality services that meet the demands identified, for example, low volume services.

Commissioning and procurement practices must deliver services that meet the requirements of the Care Act and all related statutory guidance. Re-commissioning and replacing services represents a particular challenge and should be carried out so as to maintain quality and service delivery that supports the wellbeing of people who need care and support and carers, and guards against the risk of a discontinuity of care and support for those receiving services. For example, multiple contracts terminating around the same time may destabilise local markets if established providers lose significant business rapidly and staff do not transfer smoothly to new providers.

Decommissioning services where there is to be no replacement service should similarly be carried out so as to maintain the wellbeing of people who need care and support, and carers, and ensures that their eligible needs continue to be met.

The local authority should consider the contract arrangements they make with providers to deliver services, including the range of block contracts, framework agreements, spot contracting or ‘any qualified provider’ approaches, to ensure that the approaches chosen do not have negative impacts on the sustainability, sufficiency, quality, diversity and value for money of the market as a whole – the pool of providers able to deliver services of appropriate quality.

A local authority’s own commissioning should be delivered through a professional and effective procurement, tendering and contract management, monitoring, evaluation and decommissioning process that must be focused on providing appropriate high quality services to individuals to support their wellbeing and supporting the strategies for market shaping and commissioning, including all the themes set out in this guidance.

The local authority should ensure that it understands relevant procurement legislation, and that its procurement arrangements are consistent with such legislation and best practice. It should be aware there is significant flexibility in procurement practices to support effective engagement with provider organisations and support innovation in service delivery, potentially reducing risks and leading to cost-savings. The Government has produced guidance on when reserved contracts may be allowable for organisations employing a significant number of disabled people.

4.5 Front line social work practice

The local authority should ensure that its procurement and contract management and monitoring systems provide direct and effective links to care service managers and social workers to ensure the outcomes of service delivery matches the individual’s care and support needs, and that where the local authority arranges services, people are given a reasonable choice of provider. Contract management should take account of feedback from people receiving care and support.

The local authority should ensure that where they arrange services, the assessed needs of a person with eligible care and support needs is translated into effective, appropriate commissioned services that are adequately resourced and meet the wellbeing principle (see Promoting Wellbeing chapter). For example, short home-care visits of 15 minutes or less are not appropriate for people who need support with intimate care needs, though such visits may be appropriate for checking someone has returned home safely from visiting a day centre, or whether medication has been taken (but not the administration of medicine) or where they are requested as a matter of personal choice.

4.6 Preventing abuse and neglect

When commissioning services, the local authority should pay particular attention to ensuring that providers have clear arrangements in place to prevent abuse or neglect. This should include assuring itself, through its contracting arrangements, that a provider is capable and competent in responding to allegations of abuse or neglect, including having robust processes in place to investigate the actions of members of staff. The local authority should be clear what information they expect from providers (for example, where there are allegations of abuse, what action the provider is taking or has taken and what the outcome is) and where providers are expected to call upon local authorities to lead a section 42 enquiry (where the management of the provider is implicated for instance), or to involve the Integrated Care Board (for health matters) or police (for example, in the case of potential crimes). There should be clear agreement about how local partners work together on investigations and their respective roles and responsibilities.

4.7 Financial sustainability

When commissioning services, the local authority should undertake due diligence about the financial sustainability and effectiveness of potential providers to deliver services to agreed criteria for quality, and should assure themselves that any recent breaches of regulatory standards or relevant legislation by a potential provider have been corrected before considering them during tendering processes. For example, where a provider has previously been in breach of national minimum wage legislation, a local authority should consider every legal means of excluding them from the tendering process unless they have evidence that the provider’s policies and practice have changed to ensure permanent compliance.

Contracts should incentivise value for money, sustainability, innovation and continuous improvement in quality and actively reward improvement and added social value. Contracts and contract management should manage and eliminate poor performance and quality by providers and recognise and reward excellence.

The local authority has a duty to consider added social value when letting contracts through the Public Services (Social Value) Act 2012, and are required to consider how the services it procures, above relevant financial thresholds, might improve the economic, social and environmental wellbeing of the area. The local authority should consider using this duty to promote added value in care and support both when letting contracts to deliver care and support, and for wider goods and services. This should include considering whether integrated services, voluntary and community services and ‘community capital’ could be enhanced, recognising that these community assets provide the bedrock of care and support that commissioned and bought services supplement. Local authorities should consider the range of funding mechanisms that are available to support market interventions to support community based organisations such as seed funding and grants.

All services delivered should adhere to national quality standards, with procedures in place to assure quality, safeguarding, consider complaints and commendations, and continuing value for money, referencing the Care Quality Commission (CQC) standards for quality and its quality ratings.

The local authority may consider delegating some forms of contracting to brokers and people who use care and support to support personal choice for people who are not funded by the local authority and those taking direct payments, with appropriate systems in place to underpin the delivery of safe, effective appropriate high quality services through such routes. Where functions and activities are delegated, local authorities should ensure that appropriate elements of this statutory guidance are included in contractual conditions, for example, allowing engagement in developing Market Position Statements. Local authorities should also consider providing support to people who wish to use direct payments to help them make effective decisions through, for example, direct payment support organisations.

Local authority procurement and contract management activities should seek to minimise burdens on provider organisations and reduce duplications, where appropriate, using and sharing information, with for example the CQC.

Recognising that procurement is taking place against a backdrop of significant demand on commissioners to achieve improved value for money and make efficiencies, local authorities should consider emerging practice on achieving efficiencies without undermining the quality of care.

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This chapter provides information for multi-agency practitioners in relation to how local agencies must work together, with the aim of preventing, delaying or reducing needs and promoting the wellbeing of adults with care and support needs.

RELATED SECTIONS AND CHAPTERS

Safeguarding Enquiries Process

Out of Area Arrangements

South Tyneside Multi Agency Information Sharing Agreement

Safeguarding Children

1. Introduction

Under the Care Act 2014, the local authority has a duty to carry out their care and support responsibilities – including carer’s support and prevention services – with the aim of joining up services with those provided by the NHS and other health related services, for example, housing or leisure services.

The duty applies where the local authority considers that integration of services would promote the wellbeing of adults with care and support needs – including carers, contribute to the prevention or delay of developing care needs, or improve the quality of care in the local authority’s area.

2. Integrating Care and Support with other Local Services

There is a requirement that:

  • the local authority must carry out its care and support responsibilities with the aim of promoting greater integration with NHS and other health related services;
  • the local authority and its relevant partners must cooperate generally in performing their functions related to care and support; and supplementary to this;
  • in specific individual cases, the local authority and its partners must cooperate in performing their respective functions relating to care and support and carers wherever they can.

This applies to all the local authority’s care and support functions for adults with needs for care and support and for carers, including:

The local authority is not solely responsible for promoting integration with the NHS, and this responsibility reflects similar duties placed on NHS England and Integrated Care Boards (ICBs) to promote integration with care and support. There is also an equivalent duty on local authorities to integrate care and support provision with health related services, for example housing.

3. Multi Agency Working: Preventing Abuse and Neglect

See also Preventing Abuse and Neglect

Safeguarding adults from abuse and neglect is a fundamental part of the Care Act 2014. Identification and management of risk is an essential part of any assessment undertaken by a professional working with adults.

As noted above, the local authority must cooperate with its partners, and those partners must also cooperate with the local authority to provide care and support, and safeguard adults.

Relevant partners of the local authority include neighbouring authorities with whom they provide joint shared services and the following agencies or bodies who operate within the local authority’s area including:

  • NHS England;
  • Integrated Care Boards (ICBs);
  • NHS trusts and NHS foundation trusts;
  • Department for Work and Pensions;
  • the police;
  • prisons;
  • probation services.

The local authority must also cooperate with such other agencies or bodies as it considers appropriate in exercising its adult safeguarding functions, including (but not limited to):

  • general practitioners;
  • dentists;
  • pharmacists;
  • NHS hospitals;
  • housing, health and care providers.

All agencies should stress the need for preventing abuse and neglect wherever possible. Observant professionals and other staff making early, positive interventions with individuals and families can make a significant difference to their lives; preventing the deterioration of a situation or the breakdown of a support network. It is often when people become increasingly isolated and cut off from families and friends that they become extremely vulnerable to abuse and neglect.

All agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adult procedures.

Partners should ensure that they have the mechanisms in place that enable early identification and assessment of risk, through timely information sharing and multi-agency working. Multi-agency safeguarding hubs may be one model to support this but are not the only one. Policies and strategies for safeguarding adults should include measures to minimise the circumstances, including isolation, which make adults vulnerable to abuse.

See also Safeguarding Case Studies.

4. Integration and Cooperation: Safeguarding

Safeguarding requires collaboration between partners in order to create a framework of inter-agency arrangements.

The Care Act 2014 requires that local authorities and their relevant partners must collaborate and work together as set out in the cooperation duties in the Care Act and, in doing so, must, where appropriate, also consider the wishes and feelings of the adult on whose behalf they are working.

Local authorities may cooperate with any other body they consider appropriate where it is relevant to their care and support functions. The lead agency with responsibility for coordinating adult safeguarding arrangements is the local authority, but all the members of the South Tyneside Safeguarding Children and Adults Partnership should designate a lead officer. Other agencies should also consider the benefits of having a lead for adult safeguarding.

5. Strategic Planning

5.1 Integration with health and health related services

To ensure greater integration of services, the local authority should consider the different mechanisms through which it can promote integration, for example:

  • planning: using adult care and support and public health data to understand the profile of the population and the needs of that population, for example, using information from the local Joint Strategic Needs Assessments (JSNA) to consider the wider need of that population in relation to housing (see Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies);
  • commissioning: utilising JSNA data, joint commissioning can result in better outcomes for populations in the local area. This may include jointly commissioned advice services covering healthcare and housing, and services like housing related support that can provide a range of preventative interventions alongside care;
  • assessment and information and advice: this may include integrating an assessment with information and advice about housing options on where to live, and adaptations to the home, care
  • and related finance to help develop a care plan, and understand housing choices reflecting the person’s strengths and capabilities to help achieve their desired outcomes;
  • delivery or provision of care and support: this is integrated with an assessment of the home, including general upkeep or scope for aids and adaptations, community equipment of other modifications could reduce the risk to health, help maintain independence or support reablement or recovery.

Joint Strategic Needs Assessments and Joint Local Health and Wellbeing Strategies are, therefore, key means by which local authorities work with Integrated Care Boards (ICBs) to identify and plan to meet the care and support needs of the local population, including carers.

6. Cooperation of Partner Organisations

Cooperation between partners should be a general principle for all those concerned, and all should understand the reasons why cooperation is important for those people involved. There are five aims of cooperation relevant to care and support, although the purposes of cooperation should not be limited to these matters:

  1. promoting the wellbeing of adults needing care and support and of carers;
  2. improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
  3. smoothing the transition from children’s to adults’ services;
  4. protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect;
  5. identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.

6.1 Who must cooperate?

The local authority must cooperate with each of its relevant partners, and the partners must also cooperate with the local authority, in relation to relevant functions. There are specific ‘relevant partners’ who have a reciprocal responsibility to cooperate. These are:

  • other local authorities within the area (in multi-tier authority areas, this will be a district council);
  • any other local authority which would be appropriate to cooperate with in a particular set of circumstances (for example, another authority which is arranging care for a person in the home area);
  • NHS bodies in the authority’s area (including primary care, Integrated Care Boards, any hospital trusts and NHS England, where it commissions health care locally);
  • local offices of the Department for Work and Pensions (such as Job Centre Plus);
  • police services in the local authority areas and prisons and probation services in the local area.

There may be other persons or bodies with whom a local authority should cooperate, in particular independent or private sector organisations for example care and support providers, NHS primary health providers, independent hospitals and private registered providers of social housing, the Care Quality Commission and regulators of health and social care professionals.

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This chapter provides information for multi-agency practitioners about how to raise concerns at work, known as whistleblowing. It includes information for staff who have concerns about something they have witnessed, been told about or have other suspicions about wrongdoing in the workplace.

RELEVANT GUIDANCE

Speak Up – free, independent, confidential advice on the speaking up process

Whistleblowing for Employees (gov.uk)

Whistleblowing (Social Work England) 

Raising a Concern with CQC: A Quick Guide for Health and Social Care Staff about Whistleblowing

September 2022: This chapter has been reviewed and updated throughout. Links to sources of support and advice for staff who have concerns have also been added.  See above and the appendices.

1. Introduction

Whistleblowing, or raising a concern, is where a worker (an employee, former employee, trainee, volunteer, agency worker or member of an organisation) reports a wrongdoing to their employer or another relevant organisation. Any wrongdoing reported in this way must be in the public interest. This means it must affect others, for example the general public.

Such wrongdoing may specifically relate to:

  • criminal activity;
  • a miscarriage of justice;
  • danger to the health and safety of any individual;
  • damage to the environment;
  • a failure to comply with any legal obligation; and / or
  • the deliberate concealment of any of the above matters.

There is a difference between a member of staff raising a concern / whistleblowing and making a complaint or grievance. A grievance or private complaint is about a person’s own employment position and there is no public interest element in this. For example, a worker may raise a grievance against a colleague for breaching their confidentiality. Organisations will have a specific grievance procedure to cover such situations. This is not whistleblowing.

Adults who use services, their relatives or members of the public can also make complaints about staff or services. They can do so by making a complaint to the organisation using their complaints procedure, or something to another body such as the Care Quality Commission for example (see Section 2.1 Raising a concern). This is not whistleblowing.

Any concerns relating to an adult who is experiencing or at risk of abuse or neglect must be reported via these safeguarding adults procedures (see Safeguarding Enquiries Process section).

Legal protections for whistleblowers mean that no one acting in good faith when raising a concern will be penalised for doing so (See Section 4, Protection and Support for Whistleblowers). Any attempt to victimise employees for raising genuine concerns or attempts to prevent such concerns being raised should be regarded as a disciplinary matter.

However, knowingly and intentionally raising malicious, unfounded allegations should also be regarded as a disciplinary matter.

Whistleblowing does not:

  • require employees to investigate in any way in order to prove that their concerns are well founded (although they should have reasonable grounds for their concerns);
  • replace the organisation’s grievance procedure which is available to employees concerned about their own situation;
  • replace the organisation’s disciplinary procedure; or
  • replace the complaints procedure (whistleblowing is not the same as a complaint).

2. Information for Concerned Members of Staff

2.1 How to raise a concern

A worker can blow the whistle to their employer following the guidance in their local whistleblowing policy or to a “prescribed person or body”. Employers should investigate concerns reported to them thoroughly, promptly and confidentially. The person who has raised the concern should be told how the concern will be dealt with and provided with a timescale for a response.

A prescribed person or body provides staff with a way to raise their concern with an independent body when they do not feel able to disclose directly to their employer. When reporting concerns to a prescribed body, it must be the one which deals with the type of issue being raised, for example a disclosure about possible wrongdoing in a care home can be made to the Care Quality Commission. See Whistleblowing: list of prescribed people and bodies (gov.uk)

Workers can also report concerns to a third party such as a professional body or a member of the press. This is known as a ‘wider disclosure’. This type of disclosure must meet tougher tests in order for it to be protected, than a disclosure made to an employer or prescribed person or body.

2.2 Reporting concerns anonymously or confidentially

Concerns can be raised anonymously, but the employer or prescribed body may not be able to take the claim further if they have not been provided with all the information they need.

Whistleblowers can give their name but request confidentiality – in this situation, the person or body you tell should make every effort to protect the person’s identity.

2.3 Action as a result of raising concerns

This will depend largely on the nature of the concerns raised; the most likely outcome is that the concern will be investigated by staff within the organisation.

Where appropriate, concerns that are raised may:

  • be investigated by management, internal audit, or through the disciplinary process;
  • be investigated under another procedure, for example safeguarding adults;
  • be reported to the organisation’s standards or management committee / team;
  • be referred to the police;
  • be referred to an external auditor;
  • form the subject of an independent inquiry.

Where possible, within 10 working days, the member of staff raising the concern should receive in writing:

  • an acknowledgment the concern has been received;
  • an indication how the matter will be dealt with;
  • where applicable, an estimate of how long it will take to provide a final response;
  • information on staff support mechanisms;
  • contact details of the designated contact person dealing with their concern.

If, during the investigation, the staff member is concerned about what progress is being made, requires support or reassurance, or feel they may be being victimised or harassed as a result of making the disclosure, they should raise this with the designated contact /supporting organisation.

The designated contact should inform the staff member in writing of the outcome of their concern. However, this will not include details of any disciplinary action that may result, as this will remain confidential to the individual/s concerned.

Please note: due to the likely sensitive nature of raising concerns at work, the member of staff should discuss the matter with as few people as possible.

2.4 The staff member does not agree with the outcome

If the member of staff does not agree with the way their concerns have been dealt with by local management, they may choose to escalate their concerns to senior management.

The staff member may otherwise feel it necessary to report their concerns to an external body, however this must be appropriate for the issue concerned. See Appendix 2, Useful Organisations for a list of prescribed persons.

3. Recording

A record of concerns raised together with a record of action taken in response should be provided to the staff member who raised the concern.

4. Protection and Support for Whistleblowers

The Public Interest Disclosure Act 1998 provides legal protection against detriment for workers who raise concerns in the public interest.

Bullying, harassment or victimisation (including informal pressures) by other members of staff towards someone who raises a concern will not be tolerated.

Senior management should be vigilant and may need to take appropriate action to protect staff who raise a concern in good faith.

Staff must not threaten or take retaliatory action against whistleblowers. Anyone involved in such conduct will be subject to disciplinary procedures.

If a staff member believes they have suffered any such treatment, they should inform their manager – or suitable other person – immediately. If the matter is not remedied they should raise it formally through the organisation’s grievance procedure.

Appendix 1: Advice for Workers

Online tool to help employees decide how to raise their concern – Employees Online Tool for Raising Concerns, Whistleblowing Hotline Speak Up.

Appendix 2: Useful Organisations

Whistleblowing: list of prescribed people and bodies – contains a list of the prescribed persons and bodies.

Protect; Speak up, Stop harm – a UK whistleblowing charity which provides free independent legal advice to staff and others who wish to raise concerns about the workplace.

Speak Up – Whistleblowing Helpline

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This chapter provides outline information for multi-agency practitioners to consider when they are working with adults with care and support needs or their carers who have communication needs.

RELEVANT CHAPTERS

Information and Advice

Independent Advocacy

Independent Mental Capacity Advocates and Independent Mental Health Advocates

1. Introduction

Some adults with care and support needs, and their carers, may require the services of an interpreter, signer or another professional who has specific communication skills. This may be as a result of not having sufficient comprehension or command of spoken English or other communication difficulties, as the result of hearing problems or learning or physical disabilities for example.

Adults and carers with specific communication needs should be supported to access interpreters, signers and other communicators to ensure  their needs are met, their wellbeing promoted and their needs prevented, reduced or delayed (see Promoting Wellbeing and Preventing, Reducing or Delaying Needs). This includes adults and carers who are involved in the safeguarding process. The use of interpreters, signers or other communication aids must be considered at the very beginning of the safeguarding process to ensure that the adult is included and involved in the process, as much as possible. They should receive the same level of service as those in the local population who do not have communication needs.

2. Principles of Communication Services

There are a number of main principles that should be considered when a person has communication needs:

  • family members should not be used as interpreters / communicators;
  • neither should children (within the family or extended network) should not be used as interpreters / communicators;
  • the person acting as the interpreters / communicator should be acceptable to both the adult / carer and the local authority;
  • the adult / carer should be consulted in relation to any concerns they may have about an interpreter’s / communicator’s gender and / or religion, and issues of confidentiality and potential conflicts of interest;
  • the interpreter / communicator should declare in advance of providing the service if they have any personal knowledge of the adult / carer;
  • the interpreter / communicator should also be asked in advance about any needs they may have themselves, for example disability access, water and so on
  • the importance of confidentiality should be discussed with the interpreter / communicator prior to them first meeting the adult / carer. They should be sourced from an agency who is already contracted with the local authority and where there is an existing confidentiality agreement. If this is not possible, they must sign a confidentiality agreement prior to undertaking any work;
  • the role of the interpreter / communicator is to act solely in relation to issues of communication, not as a mediator between the adult / carer and the local authority;
  • the interpreter / communicator should be briefed before the meeting. This may include preparing them for possible disclosure and discussion of sensitive or harrowing information. They should also be briefed if an advocate will also be present (see Independent Advocacy and Independent Mental Capacity Advocates and Independent Mental Health Advocates).

Decisions about the way in which the interpreter / communicator will be used will depend on their skills and training, the needs of the adult / carer and the purpose of the meeting.

Staff working with interpreters / communicators should not use them to obtain information about racial, cultural, religious or language issues. This is not a proper use of an interpreter; also their mores and life experiences may not necessarily reflect those of the adult / carer.

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Multi-Agency Risk Panels or High Risk Panels are one type of multi-agency working on complex and high risk cases, often where agencies spend significant amounts of time responding to difficult, chaotic or problematic behaviour or lifestyles that place the person, and possibly others, at significant risk. Panels can be created with all necessary partners, both statutory and third party and will vary depending on local need of the case in question. Any situation calling for multi-agency action could be discussed at panel meetings. The panel will support agencies in their work to lower and manage risk for both individuals and the wider community.

Multi-Agency Risk Panels are based on the belief that shared decision making is the most effective, transparent and safe way to reach a decision, where there is challenge with the adult and professionals working with them to mitigate the risk; or where there is a high complex case and the risk needs to be escalated for consideration by such a panel. The purpose of the Panel is to agree a risk reduction plan that is owned and progressed by the most relevant agency with the support of necessary partners.

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This chapter provides information for practitioners about the Multi-Agency Risk Assessment Conference (MARAC) process which is a local multi-agency meeting aimed at protecting victims of domestic abuse through a range of multi-agency interventions.

RELEVANT CHAPTER

Types and Indicators of Abuse and Neglect

Domestic Abuse

RELEVANT INFORMATION AND FURTHER RESOURCES

SafeLives 

1. Introduction

A Multi-Agency Risk Assessment Conference (MARAC) is a local, multi-agency victim focused meeting where professionals meet to share information on high risk cases of domestic abuse.

Information about the risks faced by those victims, the actions needed to ensure safety, and the resources available locally are discussed, and used to create a risk management plan involving all agencies. The MARAC is part of a coordinated response to domestic abuse, incorporating representatives from statutory, community and voluntary agencies working with victims, adults experiencing or at risk of abuse or neglect, children and alleged perpetrators.

The MARAC aims to:

  • share information to increase the safety, health and wellbeing of victims / survivors and their children;
  • determine whether the alleged perpetrator poses a significant risk to any particular individual or to the general community;
  • construct and jointly implement a risk management plan that provides professional support to all those at risk and that reduces the risk of harm;
  • reduce repeat victimisation;
  • improve agency accountability; and
  • improve support for staff involved in high risk domestic abuse cases.

2. MARAC Attendance

The MARAC consists of a core group of professionals, representing the statutory and voluntary sectors. The meeting involves contribution and commitment from agencies including police, probation, children’s social care, adult social care (mental health, safeguarding adults), health, education, housing, substance misuse services, and specialist domestic abuse services. Other agencies can attend as required, when they have involvement in a case which is being discussed.

In South Tyneside, the MARAC meets fortnightly, and is chaired by a Detective Inspector from the Police’s PVP (Protecting Vulnerable People) Unit.

The victim does not attend the meeting, nor the perpetrator or Crown Prosecution Service.

3. Independent Domestic Violence Advisors

Each victim referred to the MARAC will be allocated an Independent Domestic Violence Advisor (IDVA). The IDVA is a trained specialist whose goal is the safety of domestic abuse victims, focusing on victims at high risk of harm.

The IDVA will attempt to make contact with the referrer and the victim following receipt of a MARAC referral. The IDVA’s job is to be a bridge between victims and the MARAC meeting. The IDVA will try and meet the victim beforehand, or at least talk to them on the phone, and explain how the meeting works, what it can do, and what the options are.

The IDVA will also ask if there is anything the victim would want to be discussed at the meeting.

4. Making a Referral to MARAC

Referrals can be made (and are encouraged) by any agency who identifies a victim of domestic abuse as being high risk. To make a referral into the MARAC, a Risk Checklist  needs to be completed (see Section 5 below).

A DASH Risk Checklist will enable the practitioner to determine the level of risk posed to a victim. Upon meeting the MARAC threshold for high risk, the local MARAC coordinator / administrator should be contacted regarding making a referral. The case will be submitted for the next available MARAC; however in some circumstances, an emergency MARAC meeting may be called.

5. DASH Checklist

See Resources for Identifying the Risk Victims Face, DASH Checklist (SafeLives)

The DASH Risk Checklist is for all professionals working with victims of domestic abuse, stalking and honour based abuse.

The purpose of the checklist is to give a consistent and simple to use tool to practitioners who work with victims of domestic abuse in order to help them identify those who are at high risk of harm and whose cases should be referred to a MARAC meeting in order to manage the risk. The primary audience is front line practitioners working with victims of domestic abuse who are represented at MARAC.  This will include both domestic abuse specialists, such as independent domestic violence advisors (IDVAs), and generic practitioners such as those working in a primary care health service or housing.  However, a range of agencies can use the checklist with their clients or service users.

Risk in domestic abuse situations is dynamic and can change very quickly.  Therefore, as well as being used when you receive an initial disclosure of domestic abuse, it may be appropriate to review the checklist with a client on more than one occasion.  It is designed to be used for those suffering current rather than historic domestic abuse and ideally would be used close in time to the last incident of abuse that somebody has suffered. Using an evidence based risk checklist tool increases the likelihood of the victim being responded to appropriately and therefore of addressing the risks they face.  The risk checklist provides practitioners with common criteria and a common language of risk. The risk checklisy should be introduced to the victim within the framework of an agency’s confidentiality policy, information sharing policy and protocols and its MARAC referral policies and protocols.

6. Assessing Risk

Practitioners must follow agreed protocols when referring to MARAC and children’s social care (see Local Contacts).  It is important for practitioners to use professional judgement in all cases.  The results from a checklist are not a definitive assessment of risk; they merely provide a structure to inform judgement and act as prompts to further questioning, analysis and risk management whether via a MARAC or in another way.

6.1 High risk victims

If the victim is assessed as high risk, a referral should be made to both the MARAC Coordinator and to the IDVA service. This, in itself, will not keep a victim safe and practitioners should consider what other actions are necessary including making a safeguarding referral where appropriate. Further information can be found in the South Tyneside Domestic Abuse Guide and Service Directory.

7. Interface with Safeguarding Adults

When deciding whether MARAC or safeguarding is the most appropriate process for a particular case, consideration should be given as to which process is most relevant in order to be able to resolve the issue. All involved professionals should discuss and agree the most appropriate process.

Referrals and involvement in both processes at the same time may result in confusion and duplication. Whichever process is followed, the main priority is always the safety and wellbeing of the adult (and any other adults at risk / children involved). Multi-agency safeguarding planning will be key in whatever process is used.

At MARAC meetings the adult will not be present (as may also be the case for safeguarding meetings); however either an IDVA or a victim support worker will be present to advocate on behalf of the adult.

Multi-Agency Public Protection Arrangements (MAPPA) may also need to be considered in relation to an offender (see Multi-Agency Public Protection Arrangements chapter).  Again, consideration needs to be given by all professionals as the most appropriate process.

When considering a referral to MARAC or adult safeguarding, professionals from any agency should adhere to these procedures and work to ensure the best interest of the adult.

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This chapter provides information for multi-agency practitioners about Multi-Agency Public Protection Arrangements (MAPPA) which are the statutory processes for managing violent and sexual offenders living in the community, with the aim of reducing offending and protecting the public.

RELEVANT CHAPTER

Multi-Agency Risk Assessment Panels

RELEVANT GUIDANCE

MAPPA Guidance (Ministry of Justice)

1. Introduction

The purpose of MAPPA is to help reduce the re-offending behaviour of sexual and violent offenders in order to protect the public, including previous victims, from serious harm. It should also ensure that comprehensive risk assessments are undertaken and robust risk-management plans put in place. MAPPA takes advantage of coordinated information-sharing across the agencies on each MAPPA offender, and ensures that appropriate resources are directed in a way which enhances public protection.

MAPPA is not a statutory body in itself but is a mechanism through which agencies can better discharge their statutory responsibilities and protect the public in a coordinated way.

It aims to do this by ensuring that all relevant agencies work together effectively to:

  • identify all relevant offenders complete comprehensive risk assessment that takes advantage of coordinated information sharing across the agencies; and
  • devise, implement and review robust risk management plans and focus the available resources to best protect the public from serious harm.

The NPS, police and prison service are responsible authorities required to ensure the effective management of offenders. However NHS, social services, education and housing all have a duty to cooperate under the Criminal Justice Act 2003.

2. Responsible Authorities and Duty to Cooperate Agencies

The Responsible Authority is the primary agency for MAPPA. This is the police, prison and probation service in each area, working together. The Responsible Authority has a duty to ensure that the risks posed by specified sexual and violent offenders are assessed and managed appropriately.

Other bodies have a duty to cooperate with the Responsible Authority in this task. These duty to cooperate agencies (DTC agencies) will need to work with the Responsible Authority on particular aspects of an offender’s life, for example education, employment, housing, social care. These agencies include:

  • adult and children’s social care services;
  • local education authorities;
  • youth offending teams;
  • National Health Service providers;
  • local housing authorities;
  • registered social landlords who accommodate MAPPA offenders;
  • Jobcentre Plus;
  • electronic monitoring providers;
  • UK Visas and Immigration.

3. Identification and Notification

The first stages of the process are to identify offenders who may be liable to management under MAPPA as a consequence of their caution or conviction and sentence. This responsibility falls to the agency that has the leading statutory responsibility for each offender. Offenders are placed into one of three MAPPA categories according to their offence and sentence:

  • category 1: registered sexual offenders;
  • category 2: violent and other sexual offenders (violent – 12 months or more sentence of imprisonment for violent offence, other sexual offenders and those subject to hospital orders with restrictions);
  • category 3: other dangerous offenders – a person who has been cautioned for or convicted of an offence which indicates that he or she is capable of causing serious harm and which requires multi-agency management. It could also include those offenders on a community order who are, therefore, under the supervision of the probation service.

4. Levels of Management

MAPPA offenders are managed at one of three levels according to the extent of agency involvement needed and the number of different agencies involved.

Level 1: ordinary agency management – ordinary agency management level 1 is where the risks posed by the offender can be managed by the agency responsible for the supervision or case management of the offender. The majority of offenders are managed at level 1. This involves the sharing of information but does not require multi-agency meetings.

Level 2: active multi-agency management – cases should be managed at level 2 where the offender:

  • is assessed as posing a high or very high risk of serious harm; or
  • the risk level is lower but the case requires the active involvement and co-ordination of interventions from other agencies to manage the presenting risks of serious harm; or
  • the case has been previously managed at level 3 but no longer meets the criteria for level 3; or
  • multi-agency management adds value to the lead agency’s management of the risk of serious harm posed;

Level 3: active enhanced multi-agency management – level 3 management should be used for cases that meet the criteria for level 2 but where it is determined that the management issues require senior representation from the Responsible Authority and DTC agencies. This may be when there is a perceived need to commit significant resources at short notice or where, although not assessed as high or very high risk of serious harm, there is a high likelihood of media scrutiny or public interest in the management of the case and there is a need to ensure that public confidence in the criminal justice system is maintained.

5. MAPPA Meetings

The vast majority of MAPPA offenders will be managed through the ordinary management of one agency, although this will usually involve the sharing of information with other relevant agencies.

The structural basis for the discussion of MAPPA offenders who need active interagency management, including their risk assessment and risk management, is the MAPP meeting.

The Responsible Authority agencies and the MAPPA Coordinator are permanent members of these meetings. The DTC agencies should be invited to attend for any offender in respect of whom they can provide additional support and management. The frequency of meetings depends on the level of management deemed appropriate for each offender.

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 RELEVANT CHAPTERS

Transition to Adult Care and Support

Gang Activity, Youth Violence and Criminal Exploitation affecting Children, Young People and Vulnerable Adults

LOCAL SUPPORT

Information and Support Guide for Survivors of Sexual Violence (Northumbria Police)

1. Introduction

There is, rightly, much focus on children who are victims of child sexual exploitation (CSE). However, when they reach their 18th birthday and become adults, their needs, in relation to the abuse and trauma they have experienced as children, need to be recognised by the adult services which are responsible for their care and support, in order to be able to offer them the most appropriate support and promote their wellbeing.

There are different groups of adult victims / survivors of child sexual exploitation (CSE) and organised sexual abuse.

First are those who continue to be abused by perpetrators once they turn 18, and who should be responded to through safeguarding adults processes. Second are those who are no longer being abused but disclose historic or previous CSE, which adult social care and the police have a duty to respond to if it is reported to them. Third, even when the sexual abuse, physical abuse and psychological abuse has ended, many survivors will require care and support as adults, due to complex personal issues which they may suffer as a result of the trauma they experienced. These can include mental ill health, self-harm, problematic use of drugs or alcohol and interrupted schooling or college, resulting in unemployment or low paid jobs.

In addition, some adults may also be vulnerable to organised sexual abuse (OSA), being targeted for the first time as adults not as children. In particular this applies to those who have care and support needs due to learning or physical disabilities, especially if they are in residential accommodation.

The vulnerabilities of these adults must be recognised by staff who are responsible for their care and support, so they can offer them the most appropriate support and promote their wellbeing. Whilst the focus is often on girls and young women, young men are also victims too, although it can be harder for them to report their abuse which therefore remains hidden.

This chapter provides guidance to practitioners and managers working in adult care services about working with adults affected by CSE or OSA.

2. Definitions and Terms Used

2.1 Sexual exploitation

Sexual exploitation is a form of abuse. It occurs where a person, or group of people, take advantage of an adult (including those with care and support needs) to coerce, manipulate or deceive them into sexual activity for the perpetrator/s advantage. The perpetrator uses their power to get the adult to do sexual acts for the perpetrator’s own – or other people’s – benefit or enjoyment. Children and young people can also be victims (see Safeguarding Children Partnership Procedures).

An imbalance of power is at the core of the ‘relationship’ between the perpetrator and their victim, which allows them to coerce, manipulate and / or deceive the adult. Psychological, physical and sexual abuse are often used to control them, especially to prevent them reporting the abuse to family, friends or professionals.

Sexual exploitation can vary from a one-off exploitative situation between a couple for example, to organised crimes where adults are sexually abused on a large scale, including being trafficked to different places.

Sexual exploitation may also take place in exchange for basic necessities such as food, accommodation or protection or something else that the victim needs or wants.

Sexual exploitation and abuse are criminal offences. Practitioners can seek advice from the local police public protection unit or specialised sexual exploitation multi-agency team, using anonymised examples, if required.

2.2 Gangs and groups

Some perpetrators operate on their own, but sexual exploitation / abuse can also be organised and planned by criminals who are either:

  • part of a street based gang or social group and are involved in different types of criminal activity and violence in particular geographical areas and are in conflict with other similar groups. Sexual abuse and violence are just some of the crimes they are involved in, rather than their only focus.
  • groups of two or more people who are connected through associations or networks including friendship groups. Their main purpose is to sexually exploit victims.

2.3 Grooming

Grooming is when someone builds an emotional connection with a child or an adult, to gain their trust for the purposes of sexual abuse / exploitation. This can happen in person and online. Groomers can spend considerable time gaining their victim’s trust, hiding their true abusive intentions. Their methods include:

  • giving the victim a lot of attention and making them feel wanted and loved, often through flattery;
  • being understanding and listening to them;
  • buying or giving them gifts;
  • taking them out,
  • giving them drugs or alcohol – often for the first time – and making life with them seem exciting;
  • making them believe they are in a relationship together.

2.4 Organised sexual abuse

Organised sexual abuse by groups includes:

  • repeated sexual abuse / rape by their ‘boyfriend’ and his friends;
  • being trafficked to other towns and cities for the purposes of organised sexual abuse;
  • being verbally and physically threatened / abused if they try to exit the abuse;
  • family and friends being physically threatened;
  • attempts to groom younger siblings or friends;
  • being plied with alcohol and drugs to make them compliant to the point of addiction.

2.5 Terms used in this guidance

The term exploitation is when a person gains unfair advantage over another. It is commonly used to describe the behaviour of some perpetrators in relation to adults (and children).  While it may be an appropriate term at the grooming stage of exploitation (see Section 3, Signs of Sexual Exploitation / Organised Sexual Abuse in Adults), in the most serious cases which involved rape, multiple rape, gang rape and physical violence and emotional / psychological abuse, using the term ‘exploitation’ can disguise the level of harm that is perpetrated against the victim and the seriousness of the sexual offences being committed. This chapter therefore uses the term ‘sexual exploitation / organised abuse’. This is also the approach adopted by a number of agencies, including the National Crime Agency (NCA).

3. Signs of Sexual Exploitation / Organised Sexual Abuse in Adults

The following are signs of sexual exploitation / organised abuse among adults. Practitioners working with adults who have care and support needs should look out for:

  • acquisition of money, clothes, mobile phones etc without plausible explanation;
  • gang association and / or isolation from peers / social networks;
  • unexplained absences from school, college or work;
  • being excluded from school or college for unacceptable behaviour;
  • leaving home / care without explanation and persistently going missing or returning late;
  • excessive receipt of texts/phone calls, particularly when the adult will not say who they are from;
  • returning home under the influence of drugs / alcohol;
  • showing inappropriate sexualised behaviour / having sexually transmitted infections;
  • evidence of / concerns about physical or sexual assault;
  • relationships with controlling or significantly older individuals or groups;
  • frequenting areas known for sex work;
  • concerning use of internet or other social media;
  • increasing secretiveness; and
  • self-harming or significant changes in their emotional wellbeing.

Some adults can be at increased risk of sexual exploitation. These include if they:

  • are homeless;
  • are using drugs or alcohol;
  • do not have the mental capacity to consent to sexual activity;
  • are being trafficked;
  • were sexually abused as a child.

The Care Act 2014 places a duty on local authorities to make enquiries if there are concerns that an adult with care and support needs is experiencing or at risk of abuse or neglect, and, as a result of those needs, is unable to protect themselves. This applies, for example, where an adult discloses sexual exploitation / organised abuse or if a member of the public or parent expresses concerns about an adult. See also Section 7, Taking Action.

4. Residential Care / Supported Living

When managers have concerns that adults living in residential homes or supported living arrangements – for which they are responsible – are being targeted by perpetrators, they should undertake an assessment in relation to this specific risk to identify adults who are experiencing or at risk of sexual exploitation / organised abuse. This should include people in residential care, supported living environments, and those in the process of transition from children’s services (including child protection) to adult care / adult safeguarding.

5. Transition from Children’s to Adults’ Services

When young people who have been sexually exploited move from children’s services to adult care, it is important that their needs are clearly identified and a plan is put in place to ensure ongoing support and protection. Any support needs of their parents  / carers should also be identified and addressed. See also Transition to Adult Care and Support chapter.

6. Assessments / Risk Assessments

6.1 Listening and building relationships

Many reports and enquiries about child sexual exploitation and organised sexual abuse have found that professionals, family members and the public who were raising concerns were often not properly listened to. There are also other difficulties which prevent victims coming forward.

Victims of abuse often find it difficult to talk about what happened to them, particularly if they have been sexually abused as it will require disclosing very personal details. Undertaking assessments is e a difficult time for victims / survivors, as it involves disclosing very distressing intimate information as well as taking initial steps to form trusting relationships with the professionals supporting them.

Relationships of trust need to be built over time and staff need to be appropriately skilled in active listening to pick up on small clues or unexplained changes in behaviour, which may arise during contact with adults who are experiencing / have experienced sexual abuse. Where adults do disclose concerns about sexual exploitation/abuse, these must be ‘heard’, taken seriously and acted upon. See Section 7, Taking Action.

6.2 Consent

Issues of consent are complex, and practitioners should seek advice from their manager, legal department or specialist service where they are unsure. The police should be contacted for advice if practitioners are concerned crimes have been committed against the adult.

In summary, if an adult lacks mental capacity, they cannot legally consent to have sex (see Mental Capacity chapter). Sexual acts with an adult who lacks the mental capacity to consent is sexual assault and is a criminal offence under Sexual Offences Act 2003.

Adults with mental capacity to make decisions about their sexual relationships can still be at risk of being manipulated, coerced or sexually exploited; their circumstances may still meet the safeguarding criteria. Section 42 safeguarding enquiries or other appropriate risk management planning and processes should work with the adult towards finding ways to support them in exiting the abusive situation.

In such circumstances, the power of Inherent Jurisdiction enables the courts (the High Court) to issue directions or orders to support the adult who has capacity, but is being coerced or controlled and where fear impacts their ability to give genuine and informed consent.

If the adult indicates that they want to receive a service relating to sexual exploitation – or any other intervention related to their care and support needs – they should be given all the necessary information for them to understand what is involved before giving consent for their information to be shared with other relevant practitioners as appropriate.

7. Taking Action

Staff should follow the South Tyneside Safeguarding Adults procedures, and contact adult social care regarding any concerns. A safeguarding adults discussion / meeting – with the adult at the centre of discussions – may be needed to agree and plan action. This must involve the police whose role is to investigate crimes that may have been committed, collect evidence and present the case to the Crown Prosecution Service if relevant, for a decision on  whether it is appropriate to charge the individuals (see Safeguarding Enquiries Process).

7.1 Post-abuse support

Whether or not alleged perpetrators are charged, sexual abuse often has long-lasting effects for victim-survivors and their families. These include psychological and emotional trauma affecting relationships and future parenting abilities, to mental health and substance misuse issues. These place further stress on victims and their families and a need for health and social care services.

The provision of appropriate support to those who have suffered trauma can significantly improve their lives in terms of health and family relationships. Survivors are likely to require support and therapeutic intervention for an extended period of time.

8. Supervision

See also Supervision chapter

Services should ensure that their staff receive regular supervision so they can reflect on their practice. Staff who offer direct support to sexually exploited adults may also require further intensive training and specialist support.

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RELEVANT CHAPTERS

Ordinary Residence

RELEVANT INFORMATION

Chapter 17, Prison, Approved Premises and Bail Accommodation, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Introduction

People in custody or custodial settings who have needs for care and support should be able to access the care they need, just like anyone else. In the past, responsibilities for meeting the needs of prisoners were not always clear, and this led to confusion between local authorities, prisons and other organisations and made it difficult to ensure people’s eligible needs were met. The Care Act 2014 clarifies local responsibilities for people in custody with care and support needs.

Prisoners often have complex health and care needs and experience poorer health and mental health outcomes than the general population. Research has found higher rates of mental illness, substance misuse and learning disabilities among people in custody than in the general population. Access to good, joined up health and care support services is therefore important for these groups.

All adults in custody, as well as offenders in the community, should expect the same level of care and support as the rest of the population. This is crucial to ensure that those in the criminal justice system who are in need of care and support achieve the outcomes that matter to them, and that will support them to live as independently as possible at the end of their detention.

This chapter relates only to custodial settings in England.

1.1 Role of local authorities

Adults in a custodial setting should be treated as if they are ordinarily resident in the local authority area where the custodial setting is located (see Ordinary Residence chapter).

Adults who are bailed to a particular address in criminal proceedings are treated as ordinarily resident in the local authority area where they are required to reside as part of their bail conditions.

Local authorities are responsible for the assessment of all adults who are in custody in their area and who appear to be in need of care and support, regardless of which area they came from at the start of their detention or where they will be released to. If an adult is transferred to another custodial establishment in a different local authority area, responsibility will transfer to the new area. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of such care and support needs. Access to the internet may be limited in prisons and other custodial settings, so it is important to consider the most appropriate format for information and advice to be provided, such as easy read leaflets.

Although not all local authority areas contain prisons or approved premises, all areas will be responsible for ensuring continuity of care for adults with eligible needs who are released into their area with a package of care . Similarly local authorities must support continuity of care for any of their residents moving into custody.

2. Definitions

Prison: references to a prison include young offender institutions (which hold young people aged 15 -21 years), secure training centres or secure children’s homes. A reference to a governor, director or controller of a prison includes a reference to the governor, director or controller of a young offender institution, to the governor, director or monitor of a secure training centre and to the manager of a secure children’s home. A reference to a prison officer or prisoner custody officer includes a reference to a prison officer or prisoner custody officer as a young offender institution, to an officer or custody officer at a secure training centre and to a member of staff at a secure children’s home.

Approved premises: these are premises which are approved as accommodation under the Offender Management Act 2007 for the supervision and rehabilitation of offenders, and for people on bail. They are usually supervised hostel type accommodation.

HM Prison and Probation Service (HMPPS): is an executive agency, sponsored by the Ministry of Justice. The agency is made up of HM Prison Service, Probation Service and Youth Custody Service. Within England and Wales, HMPPS are responsible for:

  • running prison and probation services;
  • rehabilitation services for people leaving prison;
  • ensuring the availability of support to stop people reoffending;
  • contract managing private sector prisons and services such as:
    • the prisoner escort service;
    • electronic tagging.

Through HM Prison Service they manage public sector prisons and the contracts for private prisons in England and Wales.

Probation Service: the probation service is responsible for working with adult offenders, both in the community and during a move from prison to the community, to reduce reoffending and improve rehabilitation. The probation service sits within HMPSS.

HM Inspectorate of Prisons / Probation: HMI Prisons is an independent inspectorate which reports on conditions for and treatment of those in prison, young offender institutions and immigration detention facilities. HMI Probation is an independent inspectorate on the effectiveness of work with adults, children and young people who have offended aimed at reducing reoffending and protecting the public.

Prisons and Probation Ombudsman (PPO): PPO investigates complaints from prisoners, those on probation and those held in immigration removal centres. The Ombudsman also investigates all deaths that occur among prisoners, immigration detainees and the residents of approved premises.

3. Information Sharing

See also South Tyneside Multi-Agency Information Sharing Agreement

Local authorities are responsible for the security of information held on people who are in custodial settings, and should develop agreements with partner agencies in line with the policies and procedures of Ministry of Justice and HMPPS which enable appropriate information sharing on individuals, including the sharing of information about risk to the prisoner and others where this is relevant. See also Information Sharing Policy Framework (gov.uk).

If a local authority is providing care and support to a person who is remanded (awaiting trial) or sentenced to custody, bailed to approved premises, or required to live in approved premises as part of a community sentence, the recent assessment and care and support plan should be shared with the custodial setting and the local authority in which it is based (if different) so that care and support may continue.

Prisons and /or prison health services should inform their local authority when someone they believe has care and support needs arrives at their establishment (see Integration, Cooperation and Partnerships chapter). The local authority may also receive requests for information from managers of custodial settings or the probation service when an adult who has already received care and support in the community is remanded or sentenced to custody. The information requested should be provided as soon as possible.

The local authority and partners in the criminal justice system should put in place processes for identifying people in custodial settings who are likely to have or to develop care and support needs. This could include when the adult is screened on arrival at the prison or during health assessments.

4. Assessments of Need

When a local authority is informed that an adult in a custodial setting may have care and support needs, they must carry out an assessment as they would for someone in the community. The same standards and approach to assessment and decision making about whether someone has care and support needs should apply to adult in custodial settings, as to those who are not in the criminal justice setting, bearing in mind that an adult in prison will no longer have the same level of support they may have relied upon in the community. It is likely that there will be complexities for carrying out assessments in custodial settings and consideration should be given to how such assessments will be carried out in the most efficient way for all involved.

The local authority may also combine a needs assessment with any other assessment it is carrying out, or it may carry out assessments jointly with, or on behalf of another organisation, for example prisoners’ health assessments.

Adults in a custodial setting also have a right to self-refer for an assessment. The local authority should provide appropriate types of care and support prior to completion of the assessment, if the person has urgent needs.

If an adult in a custodial setting refuses a needs assessment, the local authority is not required to carry out the assessment, unless:

Once a local authority has assessed an adult in custody as needing care and support it must decide if some or all of these needs meet the eligibility criteria.

Where an adult does not meet the eligibility criteria, they must be given written information about:

  • what can be done to meet or reduce their needs and what services are available; and
  • what can be done to prevent or delay the development of needs for care and support in the future.

4.1 Eligibility

The threshold for the provision of care and support does not change in custodial settings. When an adult is in a custodial setting, this should not in any way affect the assessment and recording of their eligible needs. However, the setting in which the care and support will be provided is likely to be different from community or other settings, and this should be taken into account during the care and support planning process when agreeing how best to meet the adult’s care and support needs. The extent and nature of their needs should be identified before taking into account the environment in which they live.

If a safeguarding issue is identified, the prison or approved premises management should be notified in line with with HMPPS policy on adult safeguarding.

4.2 Information

See also Information and Advice chapter

For any of the adult’s needs that are not eligible, the local authority must provide information and advice to them on how those needs can be met, and how they can be prevented from getting worse. It is good practice to copy this information to managers of custodial settings, with the adult’s consent, as this will help them manage their needs.

Prisoners, especially those serving long sentences, may develop eligible needs over the course of their prison sentence. Local authorities have a duty to provide information and advice on what can be done to prevent or delay the development of care and support needs (see Preventing, Delaying or Reducing Needs chapter). Low level preventative support and information and advice can help adults in custody maintain their own health and wellbeing.

4.3 Choice of accommodation

The right to a choice of accommodation does not apply to those in a custodial setting except when an adult is preparing for release or resettlement in the community.

It is important that, where appropriate, adults in custodial settings, are supported to maintain links with their families, as long as this in the best interests of the adult and there are no public protection requirements or safeguarding concerns which may limit or prohibit family or other personal contact. While it may not always be possible or appropriate to involve family members directly in assessment or care planning, the adult should be asked whether they would like to involve others in these processes.

If it is not possible to involve families directly, the local authority should ask the adult if they would like others to be informed that an assessment is taking place and the outcome of that assessment and any care and support plan.

5. Carer’s Assessments

Prisoners, residents of approved premises or staff in prisons or approved premises will not take on the role of carer as defined by the Care Act and should therefore not in general be entitled to a carer’s assessment.

6. Charging and Assessing Financial Resources

As in the community, adults in custodial settings will be subject to a financial assessment to decide how much they may pay towards the cost of their care and support. Where it is unlikely the adult will be required to contribute towards the cost of their care and support ‘light touch’ assessments can be carried out. It the adult does not meet the eligibility threshold for local authority support, but wants to purchase care services, this request should be referred for decision to HMPPS.

7. After the Assessment

The local authority should ensure that all relevant partners are involved in care and support planning and take part in joint planning with health partners.

Where a local authority is required to meet needs for care and support, a care and support plan must be prepared.  The adult should be involved in this process. The local authority should also involve others concerned with the adult’s health and wellbeing, including prison staff, probation offender managers, staff of approved premises and health care staff, to ensure integration of care, as well as what is possible within the custodial regime. Any safeguarding issues are to be addressed in the care and support plan.

While every effort should be made to put adult’s in control of their care and for them to be actively involved and be able to influence the planning process. It should be explained that the custodial setting may limit the range of care options available and some, such as direct payments, do not apply in a custodial setting. Where an adult’s ability to exercise choice and control is limited in this way, this should be discussed with them and recorded as part of the care planning process. However, the plan must contain the elements as outlined in Chapter 10 Care and Support Planning, Care and Support Statutory Guidance, including the allocated personal budget. This will ensure that the adult is clear about the needs to be met, the cost of meeting those needs and how being in custody means their choice and control is limited.

The local authority should seek consent from the adult so that their care plans can be shared with other providers of custodial and resettlement services including custodial services, the probation service, prison healthcare providers and managers of approved premises as relevant. For residents of approved premises, the local authority should always liaise with the responsible offender manager in probation services.

7.1 Equipment and adaptations

If an adult needs equipment or adaptations to meet their care and support needs, this should be discussed with the prison, approved premises and health care services to identify which agency is responsible for providing them. Where this relates to fixtures and fittings (for instance a grab rail or a ramp), it will usually be for the prison to deliver this. But for specialised and moveable items such as beds and hoists, then it may be the local authority that is responsible. Aids for adults are the responsibility of the local authority, whilst more significant adaptations would the responsibility of the custodial establishment. See Adult Social Care Prison Service Instruction.

Care and support plans for those in custodial settings are reviewed in the same way as all other plans. The local authority should also review the adult’s care and support plan each time they go into custody from the community, or are released from custody.

8. Direct Payments

Direct payments do not apply in prisons and approved premises, and cannot be made to people in custodial settings.

Adults living in bail accommodation or approved premises who have not yet been convicted are entitled to direct payments, as they would have been whilst in their own homes.

9. Continuity of Care and Support when an Adult Moves

Adults in custody with care and support needs must have continuity of care if they are moved to another custodial setting and when they are being released from prison back into the community. Adults in custody cannot be said to be ordinarily resident there because the concept of ordinary residence is based on the person living there voluntarily. This means they might be ordinarily resident where they previously lived. However, it is the local authority where the custodial setting is situated which is responsible for assessments and services while the adult is in custody. When an adult is being released from prison, their ordinary residence will generally be in the local authority where they intend to live on a permanent basis.

There will be circumstances where the process to ensure continuity of care will need to differ, for example when a prisoner is moved between establishments or when they are released in another area because of the nature of their offence. The prison or approved premises to which an adult is allocated is decided by the Ministry of Justice, and adults can be moved between different custodial settings. In such cases, the Governor of the prison or a representative, should inform the local authority in which the prison is located (the first authority) that the adult is to be moved or is being released to a new area. If this is a move to a custodial setting or release into the community in the same authority, then the first authority will remain responsible for meeting the adult’s care and support needs. Where the new custodial setting or the community, if being released, is in a different local authority area (second authority), the first authority must inform the second authority of the move once it has been told by the prison.

The prison, both local authorities and where practicable, the adult should work together to ensure that the adult’s care and support is continued during the move. It is good practice for the first and second local authority (and the transferring and receiving prisons where appropriate) to have a named member of staff to lead on arrangements for individuals during the transfer. Both local authorities must share relevant information, including the adult’s care and support plan.

The second authority should assess the adult before they are moved, but this may not always be possible (for example, if they were informed of the transfer at short notice). In such circumstances the second authority must continue to meet the care and support needs that the first authority was meeting until it has carried out its own assessment.

10. People Leaving Prison: Ordinary Residence

The Care Act states that in most circumstances, a person’s ordinary residence is retained where they have their needs met in certain types of accommodation in another local authority area. However, this does not apply to people who are leaving prison.

Therefore, where an adult requires a specified type of accommodation (see Ordinary Residence chapter) to be arranged on release from prison to meet their eligible needs, the local authority should start from an assumption that they remain ordinarily resident in the area in which they were ordinarily resident before the start of their sentence.

However, deciding an adult’s ordinary residence on release from prison will not always be straightforward and each case must be considered on an individual basis. For example, it may not be possible for an adult to return to their prior local authority area due to the history of their case and any risks associated with them returning to that area.

In situations where an adult is likely to have needs for care and support services on release from prison or approved premises and their place of ordinary residence is unclear and / or they express an intention to settle in a new local authority area, the local authority to which they plan to move should take responsibility for carrying out their needs assessment.

Given the difficulties associated with deciding ordinary residence on release, prisons or approved premises, the probation service and the local authority providing care and support should initiate joint planning for release in advance. Early involvement of all agencies, particularly the probation service, should ensure that the resettlement plan is workable in the local authority area where the adult will live.

11. End of Life Care

The provision of care and support for those in custodial settings also applied to those who reach the end of life whilst in prison. Some adults will transfer to a local hospital, hospice or care home or move to an alternative prison for palliative care. In these cases, responsibility for care and support will pass to the NHS or new local authority, once the adult arrives at the new location. Approved premises are not usually a suitable location for the provision of end of life care.

Prison managers and health care providers should consider informing local authorities when a prisoner receives a terminal diagnosis or their condition deteriorates significantly. The adult’s consent to share such information should be obtained where possible.

Where it is not possible to obtain consent to share this information, managers of custodial settings and health care providers should make an individual assessment and consider the legal basis for sharing information (see Data Protection chapter).

Local authorities should work with the prison healthcare provider to ensure that the care and support needs of the prisoner are met throughout the provision of end of life care.

12. NHS Continuing Healthcare

NHS Continuing Healthcare (CHC) is care which is arranged and funded by the NHS and provided to adults who have been assessed as having a ‘primary health need’. It is provided to people aged 18 or over, to meet needs that have arisen as a result of disability, accident or illness. NHS Continuing Healthcare is not dependent on a person’s condition or diagnosis but is based on their specific care needs.

13. Safeguarding Adults

See Safeguarding Enquiries Process

Local authority staff and care providers must understand what to do where they have a concern about abuse and / or neglect of an adult in custody. Prison and probation staff may approach the local authority for advice and assistance with adult safeguarding concerns in individual, but the local authority does not have the legal duty to lead safeguarding enquiries in any custodial setting.

14. Transition from Children’s to Adult Care and Support

Local authorities should have processes to identify young people in young offender institutions, secure children’s homes, secure training centres or other places of detention as well as young people in the youth justice system, who are likely to have eligible needs for care and support as adults, and who are approaching their eighteenth birthday. These young people should receive a transition assessment when appropriate (see Transition to Adult Care and Support chapter).

This also applies where a young person moves from a young offender institution to an adult prison, which may change which local authority is responsible for them. A request for an assessment can be made on the young person’s behalf by the professional responsible for their care in the young offenders’ institution, secure children’s home or secure training centre.

15. Care Leavers

If a young person is entitled to care and support and services as a care leaver, this status remains unchanged while they are in custody and the local authority that looked after the young person retains responsibility for providing leaving care services during their time in custody and on release.

Local authorities have a duty to provide personal adviser (PA) support to all care leavers up to age 25, if they want this support.

16. Independent Advocacy Support

Adults in custody are entitled to the support of an independent advocate during needs assessments and care and support planning and reviews of plans if they would have significant difficulty in being involved in the process. It is the local authority’s duty to arrange an independent advocate, as they would for an individual in the community (see Independent Advocacy chapter).

The local authority should agree with managers of custodial establishments how the advocacy scheme will work in their establishments.

17. Investigations

The Prisons and Probation Ombudsman (PPO) conducts investigations in prisons following complaints about prison services, as well as deaths in custody or other significant events. The PPO will commission a relevant body to assist their investigations where it is felt that an aspect of care and support provision has contributed to the event. The local authority should co- operate with any investigations as required.

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RELEVANT CHAPTERS

Modern Slavery

Interpreting, Signing and Communication Needs

RELEVANT GUIDANCE AND INFORMATION

No Recourse to Public Funds Network

Assessing and Supporting Adults who have No Recourse to Public Funds (England) (NRPF Network)

1. Introduction and Definition

1.1 Definition of No Recourse to Public Funds

The immigration status of a person who is not a British citizen (non-UK national) determines whether they are able to work and access public funds – such as welfare benefits – in the United Kingdom (UK).

A person has no recourse to public funds (NRPF) if they are ‘subject to immigration control’. This means a person is not usually entitled to welfare benefits or public housing (although there are some exceptions).

Section 115 Immigration and Asylum Act 1999 states that a person will be ‘subject to immigration control’ if they have:

  • Permission (known as ‘leave’) to enter or remain in the UK, which has a NRPF condition attached (for example they are given permission to enter or remain on a temporary basis, such as to visit, study or work);
  • permission to enter or remain in the UK where a ‘maintenance undertaking’ is required. This is when someone else is a sponsor for a person’s immigration application and signs an agreement to say they will provide the person with accommodation and financial support whilst they are in the UK;
  • permission to enter or remain in the UK while they await the decision of their immigration appeal;
  • they do not have permission to enter or remain in the country when they are required to have this. This means that anyone who is required to have permission to enter or live in the UK but does not have this, will be subject to immigration control. This includes people who are seeking asylum and people who:
    • entered the UK illegally;
    • stayed past the date when their visa expired; or
    • are Appeal Rights Exhausted (ARE) following an unsuccessful asylum or immigration claim.

The statement ‘no public funds’ will be written on the person’s immigration documentation, if they have immigration permission with NRPF.

People who have no recourse to public funds are not usually entitled to receive welfare benefits. They also have no entitlement to local authority housing or assistance from the local authority in relation to homelessness.

There are exceptions to these rules in certain circumstances; for example, a person who has permission to remain with NRPF may still be able to claim certain benefits without this affecting their immigration status. See Public Funds Caseworker Guidance (Home Office) for more information.

1.2 Recourse to Public Funds

People with the following types of immigration status will have recourse to (be able to access) public funds:

  • indefinite leave to enter or remain or no time limit (apart from an adult dependent relative);
  • right of abode;
  • exempt from immigration control;
  • refugee status;
  • humanitarian protection;
  • leave to remain granted under the family or private life rules where they are accepted by the Home Office as being destitute or at risk of imminent destitution;
  • Hong Kong British nationals overseas BN(O) leave, when they have been accepted by the Home Office as being destitute (this means they are very poor and have no money to provide for themselves) or at risk of immediate destitution;
  • Settled status granted under the EU Settlement Scheme (EUSS) and, in some cases, pre-settled status, although they will need to satisfy a right to reside test and DWP requirements to qualify for benefits and / or local authority housing assistance;
  • discretionary leave to remain, for example:
    • leave granted to a person who has received a decision from the Home Office that they are a victim of trafficking or modern day slavery;
    • destitution domestic violence concession;
    • unaccompanied asylum-seeking child.

People who have lived in the UK for several decades can be in the country legally even if they do not have documents confirming this. In such cases, the person may be able to apply to the Windrush Scheme and apply for a document that proves they can live and work in the UK.

2. Asylum Seekers

When an asylum seeker presents to the local authority and appears to have care and support needs, they must be assessed under the Care Act 2014 in the usual way, and provided with care and support if the assessment concludes they have eligible needs.

Even if an asylum seeker is waiting for a decision from the Home Office, or the outcome of any appeal,, they are still able to receive care and support from the local authority, if the Care Act assessment concludes they are eligible.

If an asylum seeker, who has received the final decision of their asylum claim, presents to the local authority and appears to have care and support needs, they must also be assessed in the usual way under the Care Act, but the provision of care and support may be subject to a human rights assessment depending on their immigration status and whether they are in a group excluded by Schedule 3 of the Nationality, Immigration and Asylum Act 2002.

In certain circumstances, destitute refused asylum seekers may be provided with support from the Home Office under section 4 of the Immigration and Asylum Act 1999. They need to show that they:

  • are taking all reasonable steps to leave the UK;
  • are unable to leave the UK due to physical impediment;
  • have no safe route of return;
  • have been granted leave to appeal in an application for judicial review concerning their asylum claim; or
  • require support to avoid a breach of their human rights, for example they have made further submissions for a fresh asylum claim.

The support provided comprises accommodation and subsistence, which is intended to cover the costs of food, clothing and toiletries, through a card that can be used in shops but not to withdraw cash. Subsistence support cannot be provided independently of accommodation.

The following organisations provide information and asylum support:

3. Adult Safeguarding

People with no recourse to public funds may be at increased risk of domestic abuse or exploitation due to their unsettled immigration status and a lack of access to benefits and mainstream housing service.

Section 42 of the Care Act 2014 requires the local authority to undertake a safeguarding adults enquiry to decide whether any action needs to be taken to prevent or stop an adult being abused or neglected (see Safeguarding Adults chapter).

The Care and Support Statutory Guidance states that abuse or neglect includes modern slavery which covers slavery; human trafficking; forced labour; domestic servitude and where traffickers and slave masters coerce, deceive and force people into a life of abuse, servitude and inhumane treatment (see Modern Slavery chapter).

Whatever a person’s nationality or immigration status, the local authority should always follow safeguarding adults procedures and carry out a safeguarding adults enquiry and take any necessary action to stop abuse or neglect.

3.1 Modern slavery

See also Modern Slavery chapter.

Local authorities must consider and investigate when they suspect a person may be a victim of trafficking or modern slavery, or when a confirmed victim who has NRPF requests care and support or requires housing.

When a person is identified as being a potential victim of trafficking or modern slavery, the local authority must notify the National Referral Mechanism (NRM).

A referral should also be made to the NRM for support if the person consents to this.

If the person does not consent to a referral to the NRM, the local authority must still notify the Home Office.

When a referral is made to the NRM, housing and subsistence support are provided by the Salvation Army and partner organisations for 45 days.

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Ordinary Residence is used to decide which local authority is responsible for providing an adult with care and support. This chapter provides an overview for multi-agency practitioners.

RELEVANT INFORMATION

Chapter 19, Ordinary Residence, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Introduction

Local authorities are required to meet the care and support needs of adults who are ‘ordinarily resident’ in their area (or who are present there but have no settled residence). Ordinary residence is, therefore, crucial in deciding which local authority is required to meet the care and support needs of adults, and their carers. Whether the adult is ordinarily resident in a local authority area is a key test in determining where responsibilities lie for the funding and provision of care and support.

Ordinary residence is not a new concept; it has been used in care and support for many years. Usually establishing ordinary residence is straightforward, and the Care and Support Statutory Guidance contains guidance on how it is decided in some more complex situations, such as when a person is away at university for part of the year or has more than one home.

If local authorities cannot agree about ordinary residence, there is a process for appealing to the Secretary of State.

2. How does Ordinary Residence affect the Provision of Care and Support?

The test for ordinary residence is used to determine which local authority is responsible for meeting needs, applies differently in relation to adults with needs for care and support and carers. For adults with care and support needs, the local authority in which the adult is ordinarily resident will be responsible for meeting their eligible needs. For carers, however, the responsible local authority is the one where the adult being cared for is ordinarily resident.

The process of determining ordinary residence must not delay the process of meeting the adult’s care and support needs. In cases where ordinary residence is not certain, the local authority where the adult is physically present should meet the person’s needs first, while the question of ordinary residence is resolved.

3. How to Determine Ordinary Residence

Ordinary residence is not defined in the Care Act, but court cases have established that the term should be given its ordinary and natural meaning.

Local authorities should apply the principle that ordinary residence is the place a person has voluntarily adopted for a settled purpose, whether for a short or long period of time. Ordinary residence can be acquired as soon as a person moves to an area, if their move is voluntary and for settled purposes, irrespective of whether they own, or have an interest in a property in another local authority area. There is no minimum period in which a person has to be living in a particular place for them to be considered ordinarily resident there, because it depends on the nature and quality of the connection with the new place.

4. Cases where a Person Lacks Mental Capacity

See also Mental Capacity

All issues relating to ordinary residence and mental capacity should be decided with reference to the Mental Capacity Act 2005 (MCA). Under the MCA, it must always be assumed that adults have capacity to make their own decisions, including decisions about where they live and the type of accommodation they would like, unless following a mental capacity assessment it is decided they do not have mental capacity to make those decisions.

The test for mental capacity is specific to each decision at the time it needs to be made, and a person may have capacity to make some decisions but not others. It is not necessary for a person to understand local authority funding arrangements to have capacity to decide where they want to live.

If an adult lacks mental capacity to make a particular decision, the MCA explains clear how decisions should be made for them. For example, if a person lacks mental capacity to decide where to live, a best interests decision about their accommodation should be made. Any act done, or decision made (including decisions relating to where a person without mental capacity should live), must be done or made in their best interests. The MCA provides a checklist to use when working out what is in the best interests of a person who lacks mental capacity.

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This chapter provides information for multi-agency practitioners in relation to young people transitioning to adult services. It outlines the role of the local authority and partner agencies in this process when working with the young person and their carer / family.

SOUTH TYNESIDE SPECIFIC INFORMATION

Bridging the Gap: Transitional Safeguarding and the Role of Social Work with Adults – A Knowledge Briefing 

Children, Young People and Modern Slavery: A Guide for Professionals (NERSOU and the Children’s Society)

RELEVANT CHAPTERS

Integration, Cooperation and Partnerships

RELEVANT INFORMATION

Chapter 16, Transition to Adult Care and Support, Care and Support Statutory Guidance (Department of Health and Social Care)

See also Transition to Adult Care and Support Case Studies

September 2021: This chapter has been updated to include a link to Bridging the Gap: Transitional Safeguarding and the Role of Social Work with Adults – A Knowledge Briefing and Children, Young People and Modern Slavery: A Guide for Professionals, as above.

1. Introduction

Transition is the term used to describe the process which is in place to support young people and their families move from services they have received as a child into those that they need when they become an adult.

Effective person centred transition planning is essential to help young people and their families prepare for adulthood. Transition to adult care and support comes at a time when a lot of change can take place in a young person’s life. It can also mean changes to the care and support they receive from education, health and care services, or involvement with new agencies such as those who provide support for housing, employment or further education and training.

The years in which a young person is approaching adulthood should be full of opportunity. Some of the issues that matter for young people approaching adulthood, and their families, may include (but are not limited to):

  • paid employment;
  • good health;
  • completing exams or moving to further education;
  • independent living (choice and control over one’s life and good housing options);
  • social inclusion (friends, relationships and community).

The wellbeing of each young person or carer must be taken into account so that assessment and planning is based around the individual needs, wishes, and outcomes which matter to that person (see Promoting Wellbeing chapter).

Historically, there has sometimes been a lack of effective planning for people using children’s services who are approaching adulthood. Looked after children, young people with disabilities, and carers are often among the groups of people with the lowest life chances. Early conversations provide an opportunity for young people and their families to reflect on their strengths, needs and desired outcomes, and to plan ahead for how they will achieve their goals.

Professionals from different agencies, families, friends and the wider community should work together in a coordinated manner around each young person or carer to help raise their aspirations and achieve the outcomes that matter to them.

The purpose of carrying out transition assessments is to provide young people and their families with information so that they know what to expect in the future and can prepare for adulthood.

Transition assessments can develop solutions which do not necessarily involve the provision of services, and which may aid planning that helps to prevent, reduce or delay the development of needs for care or support.

2. When a Transition Assessment must be Carried Out

Transition assessments should take place at the right time for the young person or carer and at a point when the local authority can be reasonably confident about what the young person’s or carer’s needs for care or support will look like after the young person in question turns 18. There is no set age when young people reach this point; every young person and their family are different, and as such, transition assessments should take place when it is most appropriate for them.

The local authority must carry out a transition assessment of anyone in the three  groups when there is significant benefit to the young person or carer in doing so, and if they are likely to have needs for care or support after turning 18. The provisions in the Care Act relating to transition to adult care and support are not only for those who are already receiving children’s services, but for anyone who is likely to have needs for adult care and support after turning 18.

3. Significant Benefit

When considering if it is of ‘significant benefit’ to assess, the local authority should consider the circumstances of the young person or carer, and whether it is an appropriate time for the young person or carer to undertake an assessment which helps them to prepare for adulthood.

The consideration of ‘significant benefit’ is not related to the level of a young person or carer’s needs, but rather to the timing of the transition assessment.

When considering whether it is of significant benefit to assess, a local authority should consider factors which may contribute to establishing the right time to assess (including but not limited to the following):

  • the stage they have reached at school and any upcoming exams;
  • whether the young person or carer wishes to enter further / higher education or training;
  • whether the young person or carer wishes to get a job when they become a young adult;
  • whether the young person is planning to move out of their parental home into their own accommodation;
  • whether the young person will have care leaver status when they become 18;
  • whether the carer of a young person wishes to remain in or return to employment when the young person leaves full time education;
  • the time it may take to carry out an assessment;
  • the time it may take to plan and put in place the adult care and support;
  • any relevant family circumstances;
  • any planned medical treatment/

For young people with special educational needs or disabilities (SEND) who have an education, health and care (EHC) plan under the Children and Families Act 2014, preparation for adulthood must begin from year 9 – see Special Educational Needs & Disability (SEND) Code of Practice. The transition assessment should be undertaken as part of one of the annual statutory reviews of the EHC plan, and should inform a plan for the transition from children’s to adult care and support.

Equally for those without EHC plans, early conversations with local authorities about preparation for adulthood are beneficial – when these conversations begin to take place will depend on individual circumstances.

For care leavers, local authorities should consider using the statutory Pathway Planning process as the opportunity to carry out a transition assessment where appropriate.

Local authorities should not carry out the transition assessment at inappropriate times in a young person’s life, such as when they are sitting their exams and it would cause disruption. The SEND Code of Practice similarly states that local authorities must minimise disruption to the child and their family – for example by combining multiple appointments where possible. Local authorities should seek to agree the best time for assessments and planning with the young person or carer, and where appropriate, their family and any other relevant partners.

In more complex cases, it can take some time not only to carry out the assessment itself but to plan and put in place care and support. Social workers will often be the most appropriate lead professionals for complex cases. Transition assessments should be carried out early enough to ensure that the right care and support is in place when the young person moves to adult care and support.

When transition assessments take place too late and care and support is arranged in a hurry, it can result in care and support which does not best meet the young person or carer’s needs – and sometimes at greater financial cost to the local authority than if it had been planned properly in advance.

4. Requests for Transition Assessment

A young person or carer, or someone acting on their behalf, has the right to request a transition assessment. The local authority must consider such requests and whether the likely need and significant benefit conditions apply – and if so it must undertake a transition assessment.

5. Refusal of Transition Assessment

If the local authority thinks these conditions do not apply and refuses an assessment on that basis, it must provide its reasons for this in writing in a timely manner, and it must provide information and advice on what can be done to prevent or delay the development of needs for support.

Where someone is refused (or they themselves refuse) a transition assessment, but at a later time makes a request for an assessment, the local authority must again consider whether the likely need and significant benefit conditions apply, and carry out an assessment if so.

6. Identifying Young People and Young Carers who are not already receiving Children’s Services

Most young people who receive transition assessments will be children in need under the Children Act 1989 and will already be known to local authorities.

However, local authorities should consider how they can identify young people who are not receiving children’s services who are likely to have care and support needs as an adult. Key examples include:

  • young people with degenerative conditions;
  • young people (for example with autism) whose needs have been largely met by their educational institution, but who once they leave, will require their needs to be met in some other way;
  • young people detained in the youth justice system who will move to the adult custodial estate;
  • young carers whose parents have needs below the local authority’s eligibility threshold but may nevertheless require advice or support to fulfil their potential, for example a child with deaf parents who is undertaking communication support;
  • young people and young carers receiving Children and Adolescent Mental Health Services (CAMHS) may also require care and support as adults even if they did not receive children’s services from the local authority.

Even if they are not eligible for services, a transition assessment with good information and advice about support in the community can be particularly helpful for these groups as they are less likely to be aware of this.

When young people who have not been in contact with children’s services present to the local authority as a young adult, they often do so with a high level of need for care and support. Local authorities should consider how to work with education and health services to identify these groups as early as possible so they can plan and prevent the development of care and support needs (see Integration, Cooperation and Partnerships and Special Educational Needs & Disability (SEND) Code of Practice ‘Preparing for Adulthood’).

7. Adult Carers and Young Carers

Preparation for adulthood will involve assessing how the needs of young people change as they approach adulthood and also how carers’, young carers’ and other family members’ needs might change over time.

The local authority must assess the needs of an adult carer where there is a likely need for support after the child turns 18 and it is of significant benefit to the carer to do so. For instance, some carers of disabled children are able to remain in employment with minimal support while the child has been in school. However, once the young person leaves education, it may be the case that the carer’s needs for support increase, and additional support and planning is required from the local authority to allow the carer to stay in employment.

The local authority must also assess the needs of young carers as they approach adulthood. For instance, many young carers feel that they cannot go to university or enter employment because of their caring responsibilities. Transition assessments and planning must consider how to support young carers to prepare for adulthood and how to raise and fulfil their aspirations.

The local authority must consider the impact on other members of the family (or other people the authority may feel appropriate) of the person receiving care and support. This will require the authority to identify anyone who may be part of the person’s wider network of care and support. For example, caring responsibilities could have an impact on siblings’ school work, or their aspirations to go to university. Young carers’ assessments should include an indication of how any care and support plan for the person/s they care for would change as a result of the young carer’s change in circumstances. For example, if a young carer has an opportunity to go to university away from home, the local authority should indicate how it would meet the eligible needs of any family members that were previously being met by the young carer.

8. Features of a Transition Assessment

The transition assessment should support the young person and their family to plan for the future, by providing them with information about what they can expect. All transition assessments must include an assessment of:

  • current needs for care and support and how these impact on wellbeing;
  • whether the child or carer is likely to have needs for care and support after the child in question becomes 18;
  • if so, what those needs are likely to be, and which are likely to be eligible needs;
  • the outcomes the young person or carer wishes to achieve in day to day life and how care and support (and other matters) can contribute to achieving them.

Transition assessments for young carers or adult carers must also specifically consider whether the carer:

  • is able to care now and after the child in question turns 18;
  • is willing to care now and will continue to after 18;
  • works, or wishes to do so;
  • is or wishes to participate in education, training or recreation.

The young person or carer in question must be involved in the assessment for it to be person centred and reflect their views and wishes. The assessment must also involve anyone else who the young person or carer wants to involve in the assessment. For example, many young people will want their parents involved in their process.

9. Capacity

See also Mental Capacity chapter

In all cases, the young person or carer in question must agree to the assessment where they have mental capacity and are competent to agree. Where a young person or carer lacks mental capacity or is not competent to agree, the local authority must be satisfied that an assessment is in their best interests. Everyone has the right to refuse a transition assessment, however the local authority must undertake an assessment regardless if it suspects that a child is experiencing or at risk of abuse or neglect.

The right of young people to make decisions is subject to their capacity to do so as set out in the Mental Capacity Act 2005. The underlying principle of the Act is to ensure that those who lack capacity are supported to make as many decisions for themselves as possible, and that any decision made or action taken on their behalf, is done so in their best interests. This is a necessity if the transition assessment is to be person centred.

For young people below the age of 16, local authorities will need to establish a young person’s competence using the test of ‘Gillick competence’ (whether they are able to understand a proposed treatment or procedure). Where the young person is not competent, a person with parental responsibility will need to be involved in their transition assessment, – or an independent advocate provided if there is no one appropriate to act on their behalf (either with or without parental responsibility).

10. Independent Advocacy

The Care Act places a duty on local authorities to provide an independent advocate to facilitate the involvement in the transition assessment where the person in question would experience substantial difficulty in understanding the necessary information or in communicating their views, wishes and feelings – and if there is nobody else appropriate to act on their behalf (see Independent Advocacy chapter). This duty applies for all young people or carers who meet the criteria, regardless of whether they lack mental capacity as defined under the Mental Capacity Act 2005.

11. Information Sharing

When sharing information with a young carer about the person they care for a supported self-assessment during transition, the local authority must be satisfied that it is appropriate for the young carer to have the information. They must have regard to all circumstances in taking this decision, especially the age of the young carer, however each case will be different and there is no one age at which a young carer is necessarily old enough to receive information. The local authority must ensure that the adult consents to have their information shared in this way.

12. Cooperation between Professionals and Organisations

People with complex needs for care and support may have several professionals involved in their lives, and numerous assessments from multiple organisations. For children with special educational needs, the Children and Families Act 2014 brings these assessments together into a coordinated EHC plan (see SEND Code of Practice, Chapter 9).

Local authorities must cooperate with relevant partners, and this duty is reciprocal (see Integration, Cooperation and Partnerships chapter). This includes an explicit requirement which states that children and adult services must cooperate for the purposes of transition to adult care and support. Often, staff working in children’s services will have built relationships and knowledge about the young person or carer in question over a number of years. As young people and carers prepare for adulthood, children’s services and adults’ services should work together to pass on this knowledge and build new relationships in advance of transition.

It can be frustrating for children and families who have to attend multiple appointments for assessments, and who have to give out the same information repeatedly. The SEND Code of Practice highlights the importance of the ‘tell us once’ approach to gathering information for assessments and this will be important in other contexts as well. The local authority should consult with the young person and their family to discuss what arrangements they would prefer for assessments and reviews.

All relevant partners should be involved in transition planning where they are involved in the person’s care and support.

Equally, the local authority should be involved in transition planning led by another organisation, for example a child and adolescent mental health service, where there are also likely to be needs for adult care and support.

Agencies should agree how to organise transition assessments so that all the relevant professionals are able to contribute. For example, this might involve arranging a multi-disciplinary team meeting with the young person or carer. However, it may not always be possible for all the professionals from different agencies to be present at appointments, but they should still be enabled to contribute. Transition assessments must be person centred, which means that contributions by different agencies should reflect the views of the person to whom the assessment relates.

12.1 Care coordination

Many people value having one designated person who coordinates assessments and transition planning across different agencies, and helps them to navigate through numerous systems and processes that can sometimes be complicated.

Often there is a natural lead professional involved in a young person’s care who fulfils this role and the local authority should consider formalising this by designating a named person to coordinate transition assessment and planning across different agencies, and may also wish to consider setting up specialist posts carry out this coordination function for people who are preparing for adulthood.

This coordinating role, sometimes referred to as a ‘key working’ or ‘care coordination’, can not only help to deliver person centred, integrated care, but can also help to reduce bureaucracy and duplication for local authorities, the NHS and other agencies. Care coordinators are also often able to build close relationships with young people and families and can act as a valuable provider of information and advice both to the families and to local authorities. Care leavers will have Personal Advisers to provide support, for example by providing advice or signposting the young person to services. The Personal Adviser will be a natural lead in many cases to coordinate a transition from children’s to adult care and support where relevant (see also Transitions Case Studies).

13. Eligibility

Having carried out a transition assessment, the local authority must give an indication of which needs are likely to be eligible needs (and which are not likely to be eligible) once the young person in question turns 18, to ensure that the young person or carer understands the care and support they are likely to receive and can plan accordingly.

There is a particularly important role for local authorities in ensuring that young people and carers understand their likely situation when they reach adulthood. The different systems for children’s and adult care and support mean that there will be circumstances in which needs that were being met by children’s services may not be eligible needs under the adult system.

Adult care and support is subject to means testing and charging.

Where the transition assessment identifies needs that are likely to be eligible, local authorities should consider providing an indicative personal budget, so that young people, carers and their families are able to plan their care and support before entering the adult system (see SEN code of practice for further information about right to a personal budget for people with EHC plans).

For any needs that are not eligible under the adult statute, local authorities must provide information and advice on how those needs can be met, and how they can be prevented from getting worse.

14. Transition Plans

The local authority and relevant partners should consider building on a transition assessment to create a person-centred transition plan that sets out the information in the assessment, along with a plan for the transition to adult care and support, including key milestones for achieving the young person or carer’s desired outcomes.

In the case of an adult carer, if the local authority has identified needs through a transition assessment which could be met by adult services, it may meet these needs under the Care Act in advance of the child being cared for turning 18.

In deciding whether to do this the local authority must have regard to what support the adult carer is receiving under children’s legislation.

If the local authority decides to meet the adult carer’s needs through adult services, as for anyone else under the adult legislation, the adult carer must receive a support plan and a personal budget – as well as a financial assessment if they are subject to charges for the support they will receive.

15. Moving to Adult Care after the Young Person or Carer turns 18

There is no obligation on the local authority to move from children’s social care to adult care and support as soon as someone turns 18.

Very few moves will take place on the day of someone’s 18th birthday.

For the most part, the move to adult services begins at the end of a school term or another similar milestone, and in many cases should be a staged process over several months or years.

Prior to the move taking place, the local authority must decide whether to treat the transition assessment as a needs or carers assessment under the Care Act.

In making this decision the local authority must take into account when the transition assessment was carried out and whether the person’s circumstances have changed.

If the local authority will meet the young person’s or carer’s needs under the Care Act after they have turned 18 (based either on the existing transition assessment or a new needs assessment if necessary), the local authority must then undertake the care planning process as for other adults – including creating a care and support plan and producing a personal budget.

The local authority should ensure that this happens early enough that a package of care and support is in place at the time of transition.

16. Continuity of Care after the age of 18

Young people and their carers have sometimes faced a gap in provision of care and support when they turn 18, and this can be distressing and disruptive to their lives.

The local authority must not allow a gap in care and support when young people and carers move from children’s to adult services.

If transition assessment and planning is carried out as it should be, there should not be any gap in provision of care and support.

However, if adult care and support is not in place on a young person’s 18th birthday, and they or their carer have been receiving services under children’s legislation, the local authority must continue providing services until the relevant steps have been taken, so that there is no gap in provision.

The ‘relevant steps’ are if the local authority:

  • concludes that the person does not have needs for adult care and support;
  • concludes that the person does have such needs and begins to meet some or all of them (the local authority will not always meet all of a person’s needs – certain needs are sometimes met by carers or other organisations);
  • concludes that the person does have such needs but decides they are not going to meet any of those needs, for instance, because their needs do not meet the eligibility criteria under the Care Act 2014.

In order to reach such a conclusion, the local authority must have conducted a transition assessment (that they will use as a needs or carers assessment under the adult statute).

Where a transition assessment was not conducted and should have been (or where the young person’s circumstances have changed), the local authority must carry out an adult needs or carer’s assessment.

In the case of care leavers, the Staying Put Guidance (HM Government, 2013) states that local authorities may choose to extend foster placements beyond the age of 18. All local authorities must have a Staying Put policy to ensure transition from care to independence and adulthood that is similar for care leavers to that which most young people experience, and is based on need and not on age alone.

For some people with complex SEN and care needs, local authorities and their partners may decide that children’s services are the best way to meet a person’s needs – even after they have turned 18. Both the Care Act 2014 and the Children and Families Act 2014 allow for this.

The Children and Families Act enables local authorities to continue children’s services beyond age 18 and up to 25 for young people with EHC plans if they need longer to complete or consolidate their education and training and achieve the outcomes set out in their plan.

Under the Care Act 2014, if, having carried out a transition assessment, it is agreed that the best decision for the young person is to continue to receive children’s services, the local authority may choose to do so.

Children and adults’ services must work together, and any decision to continue children’s services after the child turns 18 will require agreement between children and adult services.

Where a person over 18 is still receiving services under children’s legislation through their EHC plan and the EHC plan ceases, the transition assessment and planning process must be undertaken. Where this has not happened at the point of transition, the requirement under the Care Act to continue children’s services (as set out above) applies.

Both the Children and Families Act 2014 and the Care Act 2014 also require young people and their parents to be fully involved making decisions about their care and support. This includes decisions about the most appropriate time to make the transition to adult services.

The EHC plan or any transition plan should set out how this will happen, who is involved and what support will be provided to make sure the transition is as seamless as possible.

17. Safeguarding after the age 18

Where someone is over 18 but still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with by the adult safeguarding team (see Safeguarding Enquiries Process).

Where appropriate, they should involve the local authority’s children’s safeguarding colleagues as well as any relevant partners (for example police or NHS) or other persons relevant to the case.

The same approach should apply for complaints or appeals, as well as where someone is moving to a different local authority area after receiving a transition assessment but before moving to adult care and support.

18. Transition from Children’s to Adult NHS Continuing Health Care

ICBs should use the National Framework for NHS Continuing Healthcare and supporting guidance and tools (especially the Decision Support Tool) to determine what ongoing care services people aged 18 years or over should receive.

The framework sets out that ICBs should ensure that adult NHS continuing healthcare is assessed at all transition planning meetings for all young people whose may be potential eligibility.

ICBs and LAs should have systems in place to ensure that appropriate referrals are made whenever either organisation is supporting a young person who, on reaching adulthood, may have a need for services from the other agency.

The framework sets out best practice for the timing of transition steps as follows:

  • children’s services should identify young people with likely needs for NHS Continuing Health Care and notify the relevant ICB when such a young person turns 14;
  • there should be a formal referral for adult NHS CHC screening at 16;
  • there should be a decision in principle at 17 so that a package of care can be in place once the person turns 18 (or later if agreed more appropriate).

Where a young person has been receiving children’s continuing health care, it is likely that they will continue to be eligible for a package of adult NHS CHC when they reach the age of 18.

Where their needs have changed such that they are assessed as no longer requiring such a package, they should be advised of this and of their right to request an independent review and mediation

The ICB should continue to participate in the transition process, in order to ensure an appropriate transfer of responsibilities, including consideration of whether they should be commissioning, funding or providing services towards a joint package of care.

Where it will benefit a young person with an EHC plan, local authorities have the power to continue to provide children’s services past a young person’s 18th birthday for as long as is deemed necessary.

Where there is a change in CHC provision, this must be recorded in the young person’s EHC plan, where they have one, and the young person must be advised of their right to ask the local authority for mediation up to the age of 25 (see SEND Code of Practice).

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This chapter provides guidance for practitioners about the importance of case recording in adult safeguarding, including the principles for good recording and other issues for consideration.

RELEVANT CHAPTER

Supervision

South Tyneside Multi Agency Information Sharing Agreement

1. Introduction

Good case recording is a vital component of professional practice. It supports continuity of care, risk assessment and risk management, and documents thinking, decision making and actions taken. It is a professional aid to planning and analysis. Case files are also legal documents providing an evidence trail of the work done with an adult, and their carer.

Good case recording includes a record of:

  • views of the adult and their carer;
  • work that has been undertaken;
  • the adult’s life history;
  • progress adults make towards their desired outcomes;
  • decisions made and reasons for those decisions;
  • actions undertaken and reasons for those actions;
  • professional assessment and analysis of risk.

Learning lessons from past mistakes and missed opportunities highlighted in Safeguarding Adult Reviews (see Safeguarding Adults Reviews chapter), Child Safeguarding Practice Reviews and other review reports have emphasised the need for good quality case recording especially when managing abuse, neglect and risk. This includes providing rationales for actions and decisions, whether or not they were taken, and if not the reasons for this.

Quality recording of adult safeguarding work not only helps to keep adults safe, but also protects workers by evidencing decision making based on information which was available at the time.

Case records are also a vital tool to enable staff to reflect on their practice and identify any gaps for support or development. They should be used as part of supervision, in conjunction with supervisors / managers (see Supervision chapter)

The South Tyneside Safeguarding Safeguarding Adults Board will regularly review the quality of recording as part of its performance and quality data scrutiny.

1.1 Access to records

Practitioners should bear in mind that adults, or their representatives, can request access to their files at any time. Records should, therefore, be made in line with the guidance in Section 4, Case Recording Checklist).

Case records may also be made available to the courts in the event of a safeguarding or criminal enquiry.

1.2 Using case records to support practice

Good record keeping is a vital practitioner practice tool, enabling staff to reflect on their practice, demonstrate their thinking, the rationale behind decision making, analysis of complex situations and management oversight.

The case record is not simply a record of what is happening; it should be actively used as a tool to provide a professional analysis of the situation and to develop plans to support the adult and carer.

The use of genograms, chronologies and assessment records can help organise and analyse information.

Good record keeping enables managers to identify practice gaps and ensure additional support or development opportunities are offered to staff.

Management review of adults records with their staff should be a routine part of supervision and appraisal (see Supervision chapter).

2. How Should Information be Recorded?

Social care and health staff will often be working with adults with complex needs and their carers, over a period of time. In such situations it is crucial recording is well structured in order to ensure readability, and also to allow analysis and practitioner assessments to follow on from evidence based content.

Principles of case recording include:

  • professionals must ensure records are accurate and up to date and kept in line with the recording keeping guidance of their own organisation and / or professional body;
  • records should be written with the readership in mind. They should be drawn up in partnership with the adult, and easy for them to read and understand;
  • language should be plain, clear and respectful, keeping jargon to a minimum;
  • the record should clearly separate fact from opinion;
  • there should be a clear link between evidence recorded and actions planned / recommended;
  • if handwritten, records must be legible and in black ink;
  • any alterations to handwritten records must be made by drawing a single line through the word, and correction fluid must not be used.

3. What Information should be Recorded?

The following information should be documented in each adult’s records:

  • biographical details;
  • history;
  • facts;
  • events;
  • ongoing work including discussions with other agencies and professionals, telephone calls / emails and responses to these;
  • actions taken and in relation to them the adults wishes, feelings, views and understanding of the actions should be recorded;
  • decisions made;
  • plans and contingency plans;
  • professional analysis / assessment  of evidence rationale for these and recommendations.

4. Case Recording Checklist

Case records should be recorded in accordance with the following:

  • completeness: all information relevant to the adult and their circumstances should be documented. All action plans, decisions and key conversations and phone calls should be recorded;
  • openness: as adults may request access to their file at any time;
  • accuracy: all content must be accurate, facts must be distinguished from opinion;
  • the adult’s voice: records should be drawn up in partnership with the adult and record their views, in their own words where appropriate, including whether they have given permission to share information. The adult’s voice should not be ‘missing’ from the case record. Practitioners may inadvertently focus on the views of a carer who may be more vocal, rather than the adult who may have difficulty expressing themselves;
  • up to date: records should be up to date and written up as soon as possible;
  • management oversight: files should be regularly reviewed by managers. Management involvement in casework should be clear, and decisions and recommendations dated and signed off by the relevant manager
  • summaries / continuity of care: large files should be summarised at regular intervals as the size of the record may otherwise make it difficult to manage. Records should, therefore, be focused. Important information should be highlighted and regular summaries / transfer summaries included, to make it easier to read and hand over from one member of staff to another;
  • decision making: files must include a record of decisions taken and reasons for them;
  • chronology of significant events: this should be included in the record;
  • evidence based: so all decisions are supported by facts;
  • partnership working: records should show evidence of partnership working between staff, other professionals, other agencies, adults and their carers;
  • communication needs: should be clearly addressed within the record;
  • risk management and contingency planning: files should incorporate assessment, including risk assessment and contingency plans where appropriate;
  • equalities issues: record the adult’s race  /ethnicity, gender, religion, language, disability;
  • security: all files must be kept securely and shared in accordance with data protection principles.

5. Adult Safeguarding

Safeguarding cases are some of the most high risk situations for adults and their carers. Good case recording is therefore essential to ensuring the safety and wellbeing of adults and their carers in situations where abuse or neglect are of concern.

In the case of providers registered with the Care Quality Commission (CQC), records of these should be available to service commissioners and the CQC so they can take the necessary action.

All agencies should keep clear and accurate records and follow their own agency’s recording policies.

In general, where there are safeguarding concerns regarding an adult,  there should be an audit trail of:

  • date and circumstances of concerns and subsequent action;
  • a full assessment including past incidents, concerns, risks and any patterns, as abuse and neglect often arise over a period of time, including risk assessments and risk management plans;
  • if the alleged abuser is using care and support services themselves, information about their involvement in a safeguarding enquiry, including the outcome, should be included in their case record;
  • if it is assessed that the adult continues to pose a threat to other people, this should be included in any information that is passed on to service providers or other people who need to know;
  • all contact with any adults at risk of, or experiencing abuse or neglect, and alleged perpetrators must be recorded;
  • feedback from the adult and their personal support network, using the adult’s own words where appropriate;
  • recording the exact words of alleged perpetrators;
  • all consultations with a line or senior manager;
  • consultations and correspondence with key people;
  • decision making processes and rationales;
  • advocacy and support arrangements;
  • if a decision is made not to contact the police in the case of an adult at risk of, or experiencing abuse or neglect, the details of why this decision was made and on whose authority must be recorded;
  • those who attend key meetings and safeguarding meetings must be documented;
  • the decisions taken at all meetings must be recorded;
  • safeguarding plans;
  • outcomes;
  • differences of professional opinion;
  • referrals to professional bodies;
  • it is essential to demonstrate how an assessment of risk, responsibility, rights, autonomy and protection of the adult was undertaken;
  • if no investigation is to take place, the reasons why and on whose authority this decision was taken must be recorded;
  • use a body map to illustrate physical injuries or pressure ulcers etc, when necessary.
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RELEVANT CHAPTER

Mental Capacity

RELEVANT INFORMATION

Court of Protection

Office of the Public Guardian

Advance Decision to Refuse Treatment (Living Will (NHS)

Universal Principles for Advance Care Planning

November 2023: A new section 1, Advance Care Planning, has been added to reflect guidance contained in ‘Universal principles for advance care planning’ which was published in response to the Care Quality Commission report ‘Protect, Connect, Respect – decisions about living and dying well’

1. Advance Care Planning

Advance Care Planning (ACP) is a process of discussions which an adult can choose to have with their care providers about their preferences and priorities for their future care, while they have the mental capacity to be able to have such meaningful conversations. The process, which is person-centred and likely to involve a number of conversations over time, should include whoever the adult wishes to involve, including family members or friends.

The process will enable the adult to feel more involved in their care and treatment and gives them the opportunity to reflect and share with those involved what matters most to them.

The result of these discussions may include the adult deciding one, or more, of the following:

1.1 Universal principles

The following are the universal principles of ACP and describe ‘what good looks like’ in advance care planning:

  1. The adult is central to developing and agreeing their advance care plan including deciding who else should be involved in the process.
  2. The adult has personalised conversations about their future care, focused on what matters to them and their needs.
  3. The adult agrees the outcomes of their advance care planning conversation through a shared decision making process in partnership with relevant professionals.
  4. The adult has an advance care plan which records what matters to them and their preferences and decisions about future care and treatment, that they can share with others.
  5. They have the opportunity, and are encouraged, to review and revise their advance care plan.
  6. Anyone involved in the adult’s advance care planning process is able to speak up if they feel that these universal principles are not being followed.

2. Advance Statements

An advance statement is a written statement that sets down a person’s preferences, wishes, beliefs and values regarding their future care. Its aim is to provide a guide to anyone who might have to make decisions in the person’s best interests if they lose the ability to make or communicate decisions.

A health or social care professional making a best interests decision on behalf of an adult who lacks mental capacity must take into account any advance statement that has been made, as laid down in the Mental Capacity Act (MCA). However, the advance statement is an expression of the adult’s preference and is not legally binding for a health or social care professional.

It may be difficult to challenge a professional’s decision to disregard the adult’s wishes, because they can argue they have considered  the advance statement but were acting in the person’s best interests (see Best Interests chapter).

3. Advance Decision to Refuse Treatment

An advance decision is different from an advance statement. An advance decision is a document which contains a statement that stands even if the person’s life is at risk; such as where they have refused life sustaining (continuing) treatment. This is laid out in the MCA.

The advance decision is designed to express the desires of a person who may later lack mental capacity to refuse all or some medical treatment and overrides the best interests test. It is legally binding provided the criteria under the MCA are met. In relation to refusal of treatment, the advance decision must be:

  • written;
  • made when the person has capacity;
  • made by a person over the age of 18 years and has been witnessed.

The MCA says the advance decision is not applicable to life sustaining treatment unless “it contains a statement … that it is to apply … even if the life is at risk”.

The advance decision is not applicable to life sustaining treatment unless:

  • the treatment is not the treatment specified in the advance decision;
  • any circumstances specified in the advance decision are not present;
  • there are reasonable grounds for believing that circumstances exist which the person did not anticipate at the time they made the advance decision and which would have affected their decision had they anticipated them.

An advance decision is not valid if the person:

Practitioners should be clear that advance decisions are different from advance statements.

3.1 End of life

At end of life, the best interest test applies when a patient does not have the mental capacity to make their own decisions (see Best Interests chapter). This can be a result of losing mental capacity (see Mental Capacity chapter), or through a loss of consciousness (temporary or permanent). It will cover decisions relating to palliative care (in the case of serious or life-threatening disease) and withdrawing treatment.

In the absence of a legitimate advance decision or health and welfare Lasting Power of Attorney (LPA), the decision on which treatments should or should not be provided should be made by the healthcare professionals, not the person’s relatives.

The healthcare professional must decide what is in the person’s best interests, taking all the relevant medical and non-medical circumstances into account.

4. Do Not Resuscitate

Refusing Cardiopulmonary Resuscitation (CPR) in advance (NHS) 

DNACPR stands for do not attempt cardiopulmonary resuscitation. DNACPR is sometimes called DNAR (do not attempt resuscitation) or DNR (do not resuscitate) but they all refer to the same thing

Everyone has the right to refuse Cardiopulmonary Resuscitation (CPR) if they do not want to be resuscitated, if they stop breathing or their heart stops beating.

Where the do not resuscitate decision has been made in advance, it will be recorded on a special form and kept in the person’s medical records. A DNACPR order is not permanent; it can be changed at any time.

People’s views and wishes may also be recorded in their Last Powering of Attorney (see Section 5 or Advanced Decision documents (see Section 3).

People who have a serious illness or are undergoing surgery that could cause respiratory or cardiac arrest, should be asked by a member of the medical team about their wishes regarding CPR if they have not previously made their wishes known. This should take place before they have surgery.

People should always be advised to discuss such decisions with their family or other carers, so that it is not a surprise to them should the situation arise.

If the person does not have the mental capacity to decide about CPR when a decision needs to be made (see Mental Capacity chapter) and has not made an advance decision to refuse treatment, the healthcare team should consult with their next of kin about their wishes so a decision can be made in their best interests (see Best Interests chapter).

Medical staff have a legal duty to consult and involve patients in a decision to place a ‘Do Not Resuscitate’ (DNR) order on their medical notes. Patients should always be involved in a DNR decision. There must be a convincing reason not to involve the patient, otherwise a failure to consult with them may breach their human rights. Causing potential distress to a patient is not a good enough reason not to consult with them.

5. Lasting Powers of Attorney, Court Appointed Deputy, Court of Protection and Office of the Public Guardian

5.1 Lasting Power of Attorney

Any person who has the mental capacity to understand the nature and implications of doing so may appoint another person/s to look after their affairs on their behalf. This can cover either all their affairs or be limited to specific issues. This power can be changed by the donor (the person) at any time.

A Lasting Power of Attorney (LPA) is a legal document which allows an adult to appoint an attorney to act on their behalf if they should lose mental capacity in the future. It enables the person to instruct an attorney to make decisions about their property and affairs and / or health and welfare decisions. Attorneys, in this case, can be family members or friends, who have to be registered with the Office of the Public Guardian. See Make, register or end a lasting power of attorney (gov.uk).

5.2 Court Appointed Deputy and Court of Protection

A Court Appointed Deputy is appointed by the Court of Protection (CoP). The Court of Protection has authority to make decisions on financial or welfare matters for people who cannot make decisions at the time they need to be made (because they lack mental capacity). Depending on the terms of their appointment, Court Appointed Deputies can take decisions on welfare, healthcare and financial matters as authorised by the CoP but they are not able to refuse consent to life sustaining treatment.

Any decisions made by the CoP can be challenged; for example where it is believed that a deputy is not acting in the best interests of the person they are representing and there are safeguarding concerns as a result.

5.3 Office of the Public Guardian

The Office of the Public Guardian (OPG) is the body which registers authority for LPAs and court appointed deputies. It supervises deputies appointed by the CoP and provides information to help the CoP make decisions. The OPG also works with other agencies, for example the police and adult social care, to respond to any concerns raised about the way in which an attorney or deputy is behaving.

5.4 Abuse by an Attorney or Deputy

Anyone who has concerns about the actions of a person who is a registered LPA, or a deputy appointed by the CoP, they should contact the OPG. The OPG can investigate their actions  and can also refer concerns to other relevant agencies. For more information see Report a concern about an attorney, deputy or guardian (gov.uk).

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RELEVANT INFORMATION

Mental Health Act 1983 Code of Practice

1. Introduction

Mental health and mental wellbeing can have different meanings to each individual. If a person feels well they have good mental health they will be able to cope well with day to day life, make the most of their potential and partake fully in social, family, community and work related activity.

When a person does not feel that they are in a state of good mental health, it can affect their daily activity and their perception on life, so daily life, work and socialising with family, friends, colleagues and the wider community becomes difficult.

2. Mental Health Act 1983

In legal terms, the Mental Health Act 1983 (amended 2007) does not use the expression mental health, but refers to mental disorder.

2.1 Amendments to the Act

The amendments of the MHA in 2007 simplified the previous criteria and outlined mental disorder to be ‘any disorder or disability of the mind’.

Whist mental disorder is now classified as such, a diagnosis of a learning disability does not count for detention or treatment under the Act unless it is ‘associated with abnormally aggressive or seriously irresponsible conduct.’

People with a learning disability are considered under the MHA only if they exhibit behaviour that is ‘abnormally aggressive or seriously irresponsible’. A person cannot be detained under the Act purely as a result of their learning disability alone.

Amendments to the Act also mean that people with personality disorders who used not to be detainable under the Act (because their disorders did not result in ‘abnormally aggressive or seriously irresponsible conduct on the part of the person concerned’) can now be detained.

There is still an exclusion that relates to a dependence on drink or drugs which means a person cannot be detained under the MHA 1983 solely for such a dependency, but they can be detained if it arises because of or from a mental disorder.

Chapter 2 of the Code of Practice to the MHA 1983 (2007) explains in further detail what illnesses may be considered under the Act and also references personality disorders and the MHA.

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RELEVANT CHAPTER

Mental Capacity

RELEVANT INFORMATION

Mental Capacity at a Glance (SCIE)

Determining and Recording Best Interests (39 Essex Chambers)

1. Introduction

If a person has been assessed as lacking capacity, any action taken or any decision made or on behalf of that person, must be made in their best interests. This is the fourth principle of the five principles of the Mental Capacity Act 2005 (MCA) (see Mental Capacity chapter).

The person who has to make the decision is known as the ‘decision maker’. The decision maker is usually the person closest to the decision, that is a clinician for healthcare decisions, social worker for social care decisions and a carer for day to day care decisions.

2. What are ‘Best Interests’?

The law requires a number of factors to be considered when deciding what is in the best interests of a person who lacks capacity. The checklist below details these factors. This list is not exhaustive and the MCA Code of Practice should be referred to for more details.

  • It is important not to make assumptions about someone’s best interests merely on the basis of their age, appearance, condition or any aspect of their behaviour.
  • The decision maker must consider all the relevant circumstances relating to the decision in question.
  • The decision maker must consider whether the person is likely to regain capacity (for example after receiving medical treatment). If they are likely to, can the decision or act wait until then?
  • The decision maker must involve the person as fully as possible in the decision that is being made on their behalf.
  • If the decision concerns the provision or withdrawal of life sustaining treatment, the decision maker must not be motivated by a desire to bring about the person’s death.

The decision maker must in particular consider:

  • the person’s past and present wishes and feelings (in particular if these have been written down);
  • any beliefs and values of the person (for example religious, cultural or moral) that would be likely to influence the decision in question and any other relevant factors.

As far as possible, the decision maker must consult other people if it is appropriate to do so and take into account their views as to what would be in the best interests of the person wo lacks mental capacity, especially:

The decision maker must take the above steps, amongst others, and weigh up the above factors when deciding what decision or course of action is in the person’s best interests.

For decisions about serious medical treatment or certain changes of accommodation and where there is no one who fits into any of the above categories, the decision maker may need to instruct an IMCA.

3. Where there is a Dispute about Best Interests

Family and friends may not always agree about what is in the best interests of an individual. Case records should record any details of disputes, must clearly demonstrate that decisions have been based on all available evidence and have taken into account all the conflicting views. If there is a dispute, the following courses of action can help in determining what is in a person’s best interests:

  • involve an advocate who is independent of all the parties involved;
  • get a second opinion;
  • hold a formal or informal case conference;
  • go to mediation;
  • as a last resort, an application could be made to the Court of Protection for a ruling.

4. Recording

Comprehensive recording is key in all cases, but particularly in safeguarding adults cases which are likely to be the most complex and present the highest levels of risk. In such cases, full records of best interest decision making should be kept, including:

  • how the decision about the person’s best interests was reached;
  • the reasons for reaching the decision;
  • who was consulted to help decide the best interests;
  • what particular factors were taken into account;
  • if written requests from person concerned were not followed, why not;
  • the content and results of any disputes;
  • what has been decided in the person’s best interests and reasons for that decision.

People lacking mental capacity have the same rights as those with capacity to have their outcomes realised. Although it may be challenging, a good best interests decision reflects the wishes, feelings, values and needs of the person.

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This chapter outlines the importance of close working between children and adult practitioners. Practitioners working with adults who are concerned about a child have a duty to report their concerns.

SOUTH TYNESIDE SPECIFIC LINK

South Tyneside Safeguarding Children Procedures

1. Introduction

Although the South Tyneside Safeguarding Adults Board and Safeguarding Children Partnership have has statutory duties and responsibilities as a result of different legislation (Care Act 2014; Children Act 1989, Children Act 2004, Children and Social Work Act 2017), there are significant overlaps in the processes they use, and the organisations and professionals which support the adults and children’s safeguarding partnerships to deliver their objectives.

Such areas of common work include young people transitioning between children’s and adult services (see Transition to Adult Care and Support chapter), domestic abuse (see Domestic Abuse chapter), and working with complex families. These provide potential for joint working between children’s and adults practitioners and senior managers. It is important therefore that any joint working practices or opportunities for joint working and sharing of information are explored. This offers opportunities to develop direct formal links between members who sit on the Safeguarding Adults Board and Safeguarding Children Partnership.

2. Responsibilities to Safeguard Children

See Working Together to Safeguard Children (Department for Education)

If a professional working with an adult becomes aware a child is suffering or is likely to suffer significant harm, they have a duty to safeguard and promote the welfare of the child. All staff must be aware that where there is a concern that an adult experiencing or at risk of abuse or neglect and there are children in the same household, the children too could be at risk.

As well as safeguarding and child protection issues, agencies or professionals who work with adults can also have a key role in referring a child for early help which involves relevant services providing support as soon as a problem emerges at any point in a child’s life.

In such instances staff should make reference to the South Tyneside Safeguarding Children Procedures  and / or contact South Tyneside Children’s Social Care (see Local Contacts).

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This chapter outlines the circumstances in which a referral should be made to Adult Social Care in relation to concerns about a person / people in a position of trust. It contains advice for employers / volunteer organisations and student bodies on their responsibilities to assess potential risks posed by a person in a position of trust and if necessary, to take action to prevent abuse or neglect. It also provides guidance as to how and when concerns about a person in a position of trust can be appropriately shared with an employer / volunteer organisation or student body.

RELEVANT CHAPTERS

Safer Recruitment and Employment 

Disclosure and Barring

Whistleblowing

RELATED GUIDANCE

Managing Allegations Against Staff (North East NHS)

Amendment  – In January 2023, this guidance was reviewed throughout and extensively updated. The appendices which contain the PIPOT referral form, additional guidance and templates have also been updated.

1. Introduction

This guidance has been created to support implementation of the requirements in the Care and Support Statutory Guidance that deal with ‘allegations against people in a position of trust’ (paragraphs 14.120 to 14.132). This guidance is designed to be read in conjunction with the statutory guidance and relevant information sharing guidance/ legislation.

The Care Act 2014 recognises that safeguarding concerns are not always in relation to the safety and wellbeing of an individual, but rather they relate to the possible risk posed more widely by a person in a position of trust to people with care and support needs.

Where a person is experiencing or is at risk of abuse, the online multi-agency safeguarding adults policies and procedures should be followed (see How to Report a Concern). The purpose of the online multi-agency safeguarding adults policies and procedures is to provide guidance for organisations to work together, and with one or more specific people at risk of abuse, to support them to be safe.

In both cases, this guidance will be relevant in supporting the work of all agencies to prevent abuse and neglect. Its purpose is to:

  • Explain the circumstances in which a referral can and should be made to Adult Social Care at South Tyneside Council in relation to concerns about a person / people in a position of trust;
  • Advise employers / volunteer organisations and student bodies of their responsibilities (as set out in the Care Act 2014) to assess potential risks posed by a person in a position of trust to those who use their services, and if necessary, to take action to prevent abuse or neglect;
  • Provide guidance as to how concerns about a person in a position of trust can be appropriately shared with an employer / volunteer organisation or student body to prevent abuse or neglect.

This guidance is designed to inform and support the decision making of Partnership member organisations and wider partner agencies once they become aware of a concern within the scope of this guidance.

2. Scope of this Guidance

For the purposes of this guidance:

A person in a position of trust is an employee, volunteer or student who works with adults with care and support needs. This work may be paid or unpaid

The nature of the concerns about a person in a position of trust or the risk they may to post to adults with care and support needs may be varied and wide ranging.

Examples of such concerns could include allegations that the person in a position of trust has:

  • behaved in a way that has harmed, or may have harmed an adult or child
  • possibly committed a criminal offence against, or related to, an adult or child
  • behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

(Care and Support Statutory Guidance, paragraph 14.123)

Such incidents may have occurred within the person’s home / personal life, as well as within their employment, volunteering role or studies. Wherever it has occurred however, there is now a potential risk to adults with care and support needs.

3. Referrals / Pathways: Person / People in Positions of Trust

3.1 Safeguarding Adults Concerns

Please note: if you have concerns that a specific person with care and support needs it as risk or is experiencing abuse or neglect, follow the South Tyneside Multi Agency Safeguarding Adults Policies and Procedures

Report your concerns by contacting:

0191 424 6000 (Monday to Thursday – 8.30am to 5pm, Friday 8.30am to 4.30pm)

0191 456 2093 (outside of the above office hours).

3.2  People in Position of Trust Concerns

A person in a position of trust is an employee, volunteer or student who works with adults with care and support needs. This work may be paid or unpaid.

Examples of such concerns could include allegations that they have:

  • behaved in a way that has harmed, or may have harmed an adult or child
  • possibly committed a criminal offence against, or related to an adult or child
  • behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

3.2.1 What you should do

If you are an organisation i.e. employer, volunteer manager, student body, of the person in a position of trust; you must assess and manage risk as set out in this guidance. If the person also works with another organisation, you will need to consider the need to share information to also protect people within that service (See Section 6, Information Sharing).

If you are not the person’s employer, volunteer manager, student body, or the concerns are in relation to a personal assistant, employed by a person with care and support needs; or if you need additional advice and support in relation to people in positions of trust concerns contact the South Tyneside PIPOT Lead by emailing safeguardingadults@southtyneside.gov.uk  to request a referral form or for someone to call you back to discuss the case.

See Appendix E for the PIPOT Referral Form.

4. Responsibilities of Employers / Volunteer Organisations and Student Bodies

The Care and Support Statutory Guidance sets out the responsibilities of employers:

  • The local authority’s relevant partners[1], as set out in Section 6 (7) of the Care Act 2014, and those providing universal care and support services[2], should have clear policies in line with those from the safeguarding adults board for dealing with allegations against people who work, in either a paid or unpaid capacity, with adults with care and support needs (Section 14.120)
  • Where such concerns are raised about someone who works with adults with care and support needs, it will be necessary for the employer (or student body or voluntary organisation) to assess any potential risk to adults with care and support needs who use their services, and, if necessary, to take action to safeguard those adults (Section 14.122)
  • Employers, student bodies and voluntary organisations should have clear procedures in place setting out the process, including timescales, for investigation and what support and advice will be available to individuals against whom allegations have been made (Section 14.126)
  • Employers, student bodies and voluntary organisations should have their own sources of advice (including legal advice) in place for dealing with such concerns (Section 14.126)
  • …action necessary to address the welfare of adults with care and support needs should be taken without delay and in a coordinated manner, to prevent the need for further safeguarding in future (Section 14.128)
  • If an organisation [permanently] removes an individual (paid worker or unpaid volunteer) from work with an adult with care and support needs (or would have, had the person not left first) because the person poses a risk of harm to adults, the organisation must make a referral to the Disclosure and Barring Service. It is an offence to fail to make a referral without good reason (Section 14.127. Italics comment added)

Each organisation must therefore ensure they have policies and procedures in place that enable them to respond to concerns about people in positions of trust. This must include arrangements for raising concerns to the local authority in accordance with the multi-agency safeguarding adults policies and procedures where this is appropriate, as well as the management of concerns within their own organisation.

Employers and student bodies are responsible for working with the person in a position of trust to understand the issues, assess any risk in the context of their service; and take appropriate actions that safeguard people who use their services. This will include supporting the person in position of trust to understand the process being followed and decisions reached in accordance with the organisations policies.

Only an employer has the power to suspend an employee, redeploy them or make other changes to their working arrangements, and so must be responsible and accountable for the decisions reached.  Actions taken should take into account their own internal policies and procedures, their responsibilities to provide safe services, and employment law.  According to the nature of the concerns raised, and employer/volunteers organisation/student body may also have a responsibility to inform overseeing bodies according to their requirements, such as:

  • Care Quality Commission (CQC)
  • Charity Commission
  • Commissioning Bodies
  • Disclosure and Barring Service (DBS)
  • Professional Bodies

[1] Relevant partners include NHS bodies, chief officer of the police, relevant provider of probation services.

[2] Universal care and support services will include those services available to all, such as leisure and housing services, preventative services, as well as services provided in relation to the care and support needs of adults.

5. Guidance for the Local Authority

5.1 Concerns about a person in a position of trust

If the local authority is given information about concerns that do not relate to the safety of identified adults with care and support needs, but rather the potential risk posed by a person in a position of trust, use of multi-agency procedures will not usually be the way to respond to the concerns.

In these situations, this people in positions of trust guidance will need to be followed:

Where the concern is raised by an employer, volunteer manager or student body: 

  • The local authority may need to signpost agencies to this guidance for them to take precautionary actions as appropriate in relation to identified risks.
  • Employers, volunteer managers and student bodies would need to be responsible for taking actions within this guidance as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies.
  • Employers, volunteer managers and student bodies that are raising concerns will often be best placed to share information with another employer, volunteer manager or student body, if it is so justified and necessary to do so as set out in Section 6, Information Sharing. There may, however, be circumstances where the local authority is best placed and so this decision will need to made on a case by case basis.
 Where the concern is not raised by an employer, volunteer manager or student body:

  • The local authority will need to determine whether it is justified and necessary to share the concerns with an employer, volunteer manager or student body as set out in Section 6, Information Sharing.
  • The local authority may need to signpost agencies to this guidance, for them to take precautionary actions as appropriate in relation to identified risks.
  • Employers, volunteer managers and student bodies would need to be responsible for taking actions within this guidance as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies.
Where the person in a position of trust is a personal assistant, employed by a person with care and support needs, the local authority may need to provide the employing individual with additional support to understand and manage the risks effectively and to access appropriate support.

5.2 Working within the multi-agency safeguarding adults procedures

Where the concern involving a person in a position of trust relates to an identified person or people with care and support needs, use of the multi-agency safeguarding adults policies and procedures will usually be appropriate.

In such a situation:

  • The people in positions of trust practice guidance should be followed alongside the multi-agency safeguarding adults policies and procedures.
  • Employers, volunteer organisations and student bodies retain responsibility for actions as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies.
  • to prevent abuse or neglect in their setting.
  • If, during the course of working within the multi-agency safeguarding adults policies and procedures, it is identified that the person in a position of trust may pose a risk in another setting, there will need to be a consideration as to which agency is best placed to share information as may be required with other employers, volunteer managers or student bodies to prevent abuse or neglect (see Section 6, Information Sharing). This will need to be on a case-by-case basis, taking into account the need to assess the risk and engage with the person in a position of trust as set out in this guidance.

6. Information Sharing

Where an organisation has information relating to the risk posed by a person in a position of trust, they have a responsibility to consider whether this information needs to be passed on to ensure risks are appropriately considered and managed.

Each organisation is individually responsible for ensuring that concerns relating to a person in a position of trust are shared, where necessary and appropriate, with other organisations to prevent abuse and neglect.

The potential need to share information with an employer / volunteer organisation or student body will be indicated when there is a reasonable cause to suspect that a person in a position of trust may pose a risk to adults with care and support needs within another service. This may include situations such as where:

  • a member of staff has been suspended pending a disciplinary or safeguarding enquiry, and who is known to be carrying out a similar role working within another organisation where they are assessed as potentially posing an immediate risk to others.
  • a member of staff has been dismissed due to their behaviour towards adults with care and support needs, and is also known to be undertaking professional training, for example, as a social worker or as a health professional.
  • an employee’s role and responsibilities have been changed in response to dangerous practice, but they continue to have a similar role within another organisation, where they may pose a risk to people who use that service.

Public bodies or organisations commissioned by them should be considered to be undertaking a public task as a lawful basis for sharing information. Other agencies not fulfilling public tasks should consider relying on legitimate interests as a lawful basis for sharing information.

Even where you do not have consent to share confidential information, you may lawfully share it in the public interest. Seeking consent should be the first option. However, where consent cannot be obtained or is refused, or where seeking it is inappropriate or unsafe, the question of whether there is enough public interest must be judged by the practitioner on the facts of each case. Therefore, where you have a concern about a person, you should not regard refusal of consent as necessarily precluding the sharing of confidential information.

A public interest can arise in a wide range of circumstances, for example, to protect children from significant harm, protect adults from serious harm, promote the welfare of children or prevent crime and disorder. There are also public interests which may, in some circumstances, weigh against sharing, including the public interest in maintaining public confidence in the confidentiality of certain services.

In both cases however, the judgement to be made is the same. In deciding whether sharing the information is justified and necessary, a professional judgement will be required based upon balancing the safety and needs of those potentially at risk, and the rights of the employee / volunteer or student as described below:

  • A fair balance must be struck between the rights of the person in a position of trust to privacy and the interests of those at risk of abuse and neglect. This requires a careful assessment of the severity and consequences of the interference in the life of the person in a position of trust and the risk posed to others.
  • The risks to adults with care and support needs must be sufficient to justify interfering with the person in a position of trusts’ right to privacy. The consideration is therefore one of proportionality – there should be a need for the disclosure in order to protect adults with care and support needs.

Ask yourself: is this sharing of information fair? I.e. is sharing this information something people would reasonably expect you to do in these circumstances?

  • If it is reasonably believed that the sharing of information will achieve the aim of preventing abuse or neglect, there should be no more interference in the person’s right to privacy than is necessary to achieve this aim.

Ask yourself: Am I only sharing information that it is necessary to share? You should always ensure you share no more information than is necessary to achieve your purpose.

It will be important to record your judgement, your reasons for sharing or not sharing the information, the factors you have considered and why you have give weight to some factors more than others. The recording templates (Appendix H – Template Minutes for Planning Meeting and Appendix I – Template Minutes for Case Closure Meeting can be used where it is helpful, to support decision making and the recording of decisions).

6.1 Consent and involvement of the person in a position of trust

Unless wholly impractical, before disclosing information to another employer, volunteer manager or student body, there is a need to consult with the person whose information is to be shared. This will give them the opportunity to respond to the concerns and make representation on the need to share the information.

If it is assessed as justified and necessary for the employer to be informed of the concerns / allegations, the person in a position of trust may wish to inform the employer / volunteer organisation / student body themselves.

If this is the case, their wish should be respected, but it will still be necessary to contact the employer / volunteer organisation / student body to subsequently check that relevant information has actually been passed on. It should be made clear to the person in a position of trust that this is required.

Whilst it is important to work with the person in a position of trust and seek their agreement to share information wherever possible, consent will not always be considered a lawful basis to share information in such situations. Consent must be freely given, specific and informed and the imbalance of power in such situations may mean that it cannot always be relied upon. In such cases, decisions need to be proportional to the concern as set out above.

However, this does not preclude in any way the responsibility to consult with the person in the position of trust unless it is wholly impractical to do or may place someone at risk.

7. Working with the Local Authority Designated Officer (LADO)

If there is concern that a person in a position of trust may, in the course of their work, pose a risk to child or young person under the age of 18 years, then the local authority designated officer should be notified and actions taken within the LADO process.

Sometimes, however, the risk may relate to both children / young people and adults. In such cases, there will be a need for organisations and safeguarding leads to consider their responsibilities under both this guidance and the LADO process.

For more information about the LADO and referral information:

Email: LADO@Southtyneside.gov.uk

Tel: 0191 424 6293

8. Record Keeping

Recording of discussions, decisions and disclosures are essential, and each organisation must ensure that it has process for recording this information in accordance with their own policies and any legal requirements.

Templates are available in the appendices:

Appendix H – Template Minutes for Planning Meeting

Appendix I – Template Minutes for Case Closure Meeting

9. Illustrative Examples

The examples below show how to apply this the guidance as part of an organisation’s management process:

Example 1 – John and Mary

Example 2 – Tina

Example 3 – Emma

Appendix A – Flowchart: Managing Concerns and Allegations Against People who Work with Adults with Care and Support Needs

Appendix A – PIPOT Flowchart

Appendix B – Best Practice Guidance when Deciding to Disclose Information.

Appendix B – Best Practice when Deciding to Disclose Information

Appendix C – Position of Trust Risk Balance Sheet

Appendix C- Position of Trust Risk Balance Sheet

Appendix D – Factors to Consider Regarding PIPOT Notifications

Appendix D – Factors to Consider Regarding PIPOT Notifications

Appendix E – PIPOT Referral Form

Appendix E – Allegations Against People who Work in Positions of Trust with Adults Referral / Reporting Form

Appendix F – Template Agenda for Planning Meeting

Appendix F – Template Agenda for Planning Meeting or Planning Discussion

Appendix G – Template Agenda for Case Closure Meeting

Appendix G – Template Agenda for Case Closure Meeting

Appendix H – Template Minutes for Planning Meeting

Appendix H – Template Minutes for Planning Meeting or Planning Discussion

Appendix I – Template Minutes for Case Closure Meeting

Appendix I – Template Minutes for Case Closure Meeting

 

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This chapter provides information for practitioners in relation to local multi-agency training in relation to safeguarding adults from abuse or neglect.

RELEVANT CHAPTERS

Supervision

Safer Recruitment and Employment

SOUTH TYNESIDE SPECIFIC INFORMATION

Safeguarding Training Programme Calendar

The South Tyneside Safeguarding Adults Board should ensure that relevant partners provide training for staff and volunteers on the policy, procedures and professional practices that are in place locally, which reflects their roles and responsibilities in safeguarding adult arrangements. Employers, student bodies and voluntary organisations should also undertake this, recognising their critical role in preventing and detecting abuse. This should include:

  • basic mandatory induction training with respect to awareness that abuse and neglect can take place and duty to report;
  • more detailed awareness training, including training on recognition of abuse and neglect and responsibilities with respect to the procedures in their particular agency;
  • specialist training for those who will be undertaking enquiries, and managers; and
  • training for elected members and others for example Healthwatch members; and
  • post qualifying or advanced training for those who work with more complex enquiries and responses or who act as their organisation’s expert in a particular field, for example in relation to legal or social work, those who provide medical or nursing advice to the organisation or the Safeguarding Adults Board.

Training should take place at all levels in an organisation and be updated regularly to reflect best practice. To ensure that practice is consistent – no staff group should be excluded.

Training should include issues relating to staff safety within a health and safety framework and also include volunteers. In a context of personalisation, the Safeguarding Adults Board should seek assurances that directly employed staff (for example personal assistants) have access to training and advice on safeguarding.

Training is a continuing responsibility and should be provided as a rolling programme. Whilst training may be undertaken on a joint basis and the Safeguarding Adults Board has an overview of standards and content, it is the responsibility of each organisation to train its own staff.

Regular face to face supervision from skilled managers and reflective practice is essential to enable staff to work confidently and competently with difficult and sensitive situations.

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RELEVANT CHAPTERS 

Health and Wellbeing of Staff

Each partner agency should have its own supervision policy and procedure, which is tailored to meet the needs of its staff, service and the adults and carers with whom it works.

Supervision is an accountable process which supports, assures and develops the knowledge, skills and values of an individual, group or team. The purpose of supervision is to improve the quality of work to achieve agreed objectives and outcomes. Effective supervision is an integral part of adult safeguarding practice; it is also an essential element of the performance management framework. It should support staff in developing and maintaining effective working relationships with adults and their carers and with other professionals, whilst simultaneously exercising professional judgement, effective decision making and carrying out other duties associated with their individual role. It should also tie the overarching strategic objectives of the service with the individual personalised objectives of each member of staff.

It must be educative, supportive, empowering and a benefit to supervisor, supervisee and the organisation. Supervision must be sensitive to the individuals ethnic and cultural background, disability, gender and sexual orientation.

In the reflective environment of supervision, and in conjunction with their manager, staff should be able to consider their developmental and learning needs, review identified actions necessary to address such needs and subsequently evidence practice improvement.

Good quality supervision can help to:

  • avoid drift;
  • keep focus on the adult with care and support needs;
  • maintain a degree of objectivity and challenge fixed views;
  • test and assess the evidence base for assessment and decisions;
  • address the emotional impact of work.

The supervision process should incorporate four main functions:

  • management, including performance management;
  • professional development;
  • support;
  • practice reflection.

At the outset of the supervisory relationship expectations of the supervisor and the supervisee should be established and recorded. This includes frequency of meetings, content of supervision sessions, recording of meetings and sign off, and action to be taken if either party becomes dissatisfied with the relationship, or outcomes of the sessions.

Supervision usually takes place on a one to one basis, although can also be part of a group session as well. It is a process rather than a series of single events or sessions and should complement and support the appraisal process by evidencing the continuous improvement and performance of the supervisee.

Issues discussed at each supervision session should be recorded and signed by the manager and counter signed by the staff member, who should also be provided with a copy. This may be done via email as an electronic documentation of the agreement.

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This chapter provides information about the recruitment and employment processes which organisations should use to safeguard adults from abuse and neglect.

RELEVANT CHAPTER

Disclosure and Barring

Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance

Whistleblowing

RELEVANT INFORMATION

Better Hiring Toolkit (Disclosure and Barring Service and partners)

1. Introduction

Safer recruitment, induction and supervision of staff are essential to the safeguarding of adults with care and support needs. All organisations should have generic recruitment policies and procedures in place. This chapter provides additional, specific guidance in relation to safer recruitment practices at each step of the generic recruitment process, which aims to prevent unsuitable persons from working with adults, either as a paid member of staff or volunteer whether they are permanent, temporary or agency staff or recruited from abroad. In addition, it applies to staff / volunteers who are seen by adults with care and support needs as trustworthy and / or have access to confidential information. This may include administrative staff, caretakers, and maintenance workers for example.

Commissioners should ensure the principles of safer recruitment and employment are included in service level agreements or contracts drawn up between them and service providers. A service level agreement or contract should also contain the service’s safeguarding statement (see Section 2.1 Commitment to safeguarding).

2. Safer Recruitment Practices

2.1 Commitment to safeguarding

All organisations should have a statement about their commitment to the prevention of abuse and neglect and promoting the wellbeing of adults with care and support needs, to which it is expected all staff and volunteers will abide and embed in their daily practice. This should include that robust recruitment and selection procedures are in place to identify and deter people who might abuse or neglect adults with care and support needs or who are otherwise unsuitable for employment / volunteering. The statement should be included in recruitment material such as job adverts, candidate information packs and person specifications.

2.2 Safeguarding policies

Organisations should publish a safeguarding policy for staff which clearly relates to these Safeguarding Adults Procedures, and sets out the responsibilities of all staff. It should include information on:

  • identifying adults who are particularly at risk;
  • recognising risk from different sources and in different situations and recognising abusive or neglectful behaviour from other service users, colleagues, and family members;
  • routes for making a referral and channels of communication within and beyond the agency;
  • organisational and individual responsibilities for whistleblowing (see Whistleblowing chapter);
  • assurances of protection for whistleblowers;
  • working within best practice as specified in contracts;
  • working within and co-operating with regulatory mechanisms;
  • working within agreed operational guidelines to maintain best practice in relation to:
    • challenging or distressing behaviour;
    • personal and intimate care;
    • control and restraint;
    • gender identity and sexual orientation;
    • medication;
    • handling of people’s money;
    • risk assessment and management (read risk guidance for people living with dementia).

Organisations should also produce guidance outlining the rights of staff and how employers will respond where abuse is alleged against them within either a criminal or disciplinary context (see Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance)

2.3 Job adverts

The advertisement should include the organisation’s policy statement (see Section 2.1, Commitment to safeguarding). It should also include reference to the requirement for the successful applicant to undertake a Disclosure and Barring Service check, as appropriate.

2.4 Job description

The job description (JD) should be specific about extent of contact and levels of responsibility the post holder will have for adults with care and support needs, including prevention of abuse or neglect at operational and / or strategic levels.

2.5 Person specification

The person specification (PS) should include any other requirements the post holder will need in order to perform the role in relation to working with adults with care and support needs, including experience specific to the post, for example working with adults with learning disabilities or dementia. The successful candidate should be able to demonstrate such required competencies and qualities.

2.6 Candidate information pack

The information pack should also highlight that a robust selection process is in place, and include reference to the organisation’s safeguarding adults’ policy. It should state proof of identity will be required, as well as a Disclosure and Barring Service check, as appropriate.

2.7 Application form

Employers should only use their own application forms for applicants. It is not good practice to accept curriculum vitae (CVs) instead of an application form as this may only contain information the person wants to present rather than all the information the organisation requires to enable shortlisting. The applicant form should again include reference to the organisation’s commitment to safeguarding adults with care and support needs.

2.8 Shortlisting

Application forms should be scrutinised for any unexplained gaps in employment history, or other potential concerns in relation to safeguarding adults. References should be sought on all candidates who are shortlisted for interview.

2.8.1 Requesting references

Where an applicant is not currently working with adults with care and support needs, but has done so previously, a reference should also be obtained from the last such employer, in addition to the current / most recent employer. This should include confirmation of the reason why the applicant left the post.

The referee should state:

  • whether they are satisfied the applicant has the ability and is suitable to undertake the job, and if not why;
  • whether they were the subject of any disciplinary sanctions or any allegations made against them, which relate to adults (including outcomes).

2.9 Interviews

The interview should assess the merits of the candidate against the JD and PS, and explore their suitability to work with adults with care and support needs.

The panel should state to each candidate there will be a requirement to complete an application for a Disclosure and Barring Service check, confirm their identity and receive satisfactory references.

One member of the panel should be trained in safer recruitment practice.

The panel should explore with the candidate:

  • their attitude towards adults with care and support needs, including any specific needs of adults of the service, including reasons why they want to work with such adults;
  • their ability and commitment to the organisation’s agenda for safeguarding and promoting wellbeing;
  • any gaps in their employment history;
  • discrepancies / concerns in relation to any information provided by either them or a referee;
  • if they wish to declare anything in relation to applying for a Disclosure and Barring Service check;
  • their understanding of appropriate relationships and personal boundaries;
  • emotional resilience in working with in challenging situations.

2.9.1 Participation of adults with care and support needs

Adults who use the service can make very valuable contributions as part of recruitment of new staff positions. Their participation should be built into the process at all levels, from administration posts to senior positions. Their roles should be clarified with the adults who participate, so they understand how their views will be considered and what weighting they will be given.

2.10 Conditional offer of appointment

Offers of appointment will be conditional on receipt of satisfactory checks and references.

In the following circumstances the applicant should be reported to the police:

  • they are found to be on a list concerning their suitability to work with adults / have been disqualified from working with adults by a Court;
  • they provided false information in relation to their application;
  • there are serious concerns about their suitability to work with adults.

2.10.1 Disclosure and Barring Service checks

See also Disclosure and Barring Service chapter.

The level of Disclosure and Barring Service (DBS) check requested – either Standard or Enhanced – should reflect the nature of the post and degree of contact with adults or with confidential information.

Types of DBS check are as follows:

  • Basic check: The basic check can be used for any position or purpose. A basic certificate will contain details of convictions and cautions from the Police National Computer (PNC) that are considered to be unspent under the terms of the Rehabilitation of Offenders Act (ROA) 1974.
  • Standard check: This allows employers to access the criminal record history of people working, or seeking to work, in certain positions, especially those that involve working with children or adults in specific situations. A standard check discloses details of an individual’s convictions, cautions, reprimands and warnings recorded on police systems and includes both ‘spent’ and ‘unspent’ convictions;
  • Enhanced check: This discloses the same information provided on a Standard certificate, together with any local police information that the police believe is relevant and ought to be disclosed;
  • Enhanced with barred list check: This check includes the same level of disclosure as the enhanced check, plus a check of the appropriate barred lists. An individual may only be checked against the children’s and adults’ barred lists if their job falls within the definition of ‘regulated activity’ with children and/or adults;
  • • Adult First check: adult first is a service available to organisations who can request a check of the DBS adults’ barred list. Depending on the result, a person can be permitted to start work, under supervision, with vulnerable adults before a DBS certificate has been obtained.

For guidance on which type of DBS check is appropriate for the role being advertised, please see the DBS website. 

A record of the following should be kept; date the disclosure was obtained, by whom, level of disclosure and unique reference number.

In relation to adults with care and support needs, it should be noted that in ‘signing off’ or agreeing a personal budget or personal health budget a local authority may add conditions such as a DBS check as part of its risk assessment of safeguarding in specific cases. The local authority may also require personal budget holders using direct payments to tell them who they employ.

2.10.2 Checks on overseas staff

The same checks should be made on overseas staff as for all other staff, however the Disclosure and Barring Service. cannot access criminal records held overseas, so a DBS check may not provide a complete view of an applicant’s criminal record if they have lived outside the UK.

Where an applicant has worked or been resident overseas in the previous five years, the employer should obtain a check of the applicant’s criminal record from the relevant authority in that country as well as information about their conduct. It should be noted that not all overseas organisations / countries are able to provide such information. The application process for criminal records checks or ‘Certificates of Good Character’ for someone from overseas varies between different countries. For further information, see GOV.UK – Criminal records checks for overseas applicants.

2.10.3 Agency staff

Written confirmation should be provided by the agency that the necessary checks have been undertaken and are satisfactory.

2.11 Record Keeping

In relation to each candidate who is appointed, records should be made of:

  • any specific information raised with them (for example gaps in employment history) and their explanation and any corroborating information;
  • the outcome of their Disclosure and Barring Service check including unique reference number and date (please note – DBS information should, in general, only be retained for six months after the recruitment decision, then destroyed);
  • reasons for decision to appoint despite criminal convictions, including risk assessment undertaken.

3. Induction

On starting in a new post, the member of staff should be given written information in relation to:

4. Supervision and Staff Review and Development

Regular supervision sessions should take place as per the organisation’s policies and procedures, as should annual staff reviews. Both processes aide both the organisation and member of staff by ensuring:

  • staff are up to date with current practices in relation to their specific area of work and safeguarding adults in general (both local and national issues);
  • identify areas for development;
  • provide opportunities to identify and address any concerns about behaviour and / or attitudes;
  • develop any required action plans and review arrangements.

5. Disclosure and Barring Service Rechecking

The DBS also provides an online Update Service, to which staff or volunteers can subscribe and renew annually for a small fee (free for volunteers). This helps them keep their DBS certificate up to date, so it can be taken with them from one job to another, as long as they remain within the same workforce (adults, for example). See Disclosure and Barring Service chapter, Update Service.

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This chapter provides information for practitioners about the process for adults or carers who wish to make a complaint about their experience of the safeguarding adults process, or appeal a decision that was made during the process.

Please note, the Safeguarding Adults Board is not responsible for the delivery of services in partner agencies; therefore complaints and concerns in relation to individual services/agencies do not fall within the scope of this procedure and should be dealt with directly by the responsible agency according to their own complaints process.

RELEVANT CHAPTER

Escalation and Challenge Protocol

1. Introduction

Being involved in a safeguarding process is a difficult experience for any adult who has experienced neglect or abuse, and the people who care for them.

Practitioners should make every effort to ensure that adults and their carers are fully consulted and involved in the safeguarding process, kept informed of the progress of any investigation and are at the centre of work to ensure their safety and wellbeing (see Making Safeguarding Personal chapter).

However, there will be occasions when an adult or their carer wish to make a complaint about their experience or the outcome of the safeguarding process.

Where the adult or carer wishes to make a complaint about an individual organisation, they should be directed to the organisation’s complaints procedure.

For professionals who wish to complain about an aspect of the process, please see Escalation Protocol: Resolution of Professional Disagreements between Workers Relating to the Safety of Adults.

At any stage of the complaints process, the adult or carer may bring an advocate or friend to support them. An independent advocate can make a complaint on behalf of an adult (see Independent Advocacy chapter). Some adults or carers may require interpreting or communication services (see the chapter on Interpreting, Signing and Communication Needs).

When a representative makes a complaint on behalf of the adult, written confirmation will normally be required – as far as this is possible to give – that the person is happy for this representation to take place and if appropriate for relevant information to be shared directly with the representative.

The representative in a complaint covered by this procedure will be expected to discuss  and disclose relevant details of the complaints and its progress with the adult as far as possible, and ensure that any decisions made about the complaint has their full agreement.

South Tyneside Council has the discretion to decide whether or not the person is suitable to act as a representative.  If the representation is considered to be unsuitable, or not in the adult’s best interests, the person acting as a representative will be informed in writing of the reasons why their representation has been refused.  This test of suitability will be applied when the complaint is first made, and also at relevant stages of the complaint, as appropriate.

The local authority should ensure people are given information and advice about the complaints process, that they are supported throughout and kept fully informed in writing of progress and the outcome.

2. Grounds for Complaint or Appeal

The adult who is experiencing or at risk of abuse or neglect (or advocate on their behalf) or their carer has grounds for making a complaint if they are unhappy with the manner in which they feel they have been treated during the safeguarding process.

3. Complaints Procedure

The complaints procedure has three stages.

3.1 Stage 1

The focus on Stage 1 is on putting things right.

The adult or their carer who wishes to make a complaint should first speak to a practitioner involved in the safeguarding process. This may be a social worker or health professional.

If they are not satisfied with the discussion at this level, the practitioner should ask them if they would like to speak to their line manager or the organisation’s safeguarding adult lead. The manager should discuss the situation with the adult / carer, and try to resolve the situation informally. This may be by explaining processes to them and the rationale for the decisions made or actions taken or taking action to remedy an aspect of the process. The adult / carer should be reassured that their concerns are taken seriously.

If the complaint is straightforward, it may be resolved at this stage.

The practitioner / manager should record a summary of all discussion/s which take place and the outcome (see Case Recording).

If the adult / carer remains dissatisfied ,they can ask for a formal investigation of their complaint under Stage 2 of the complaints procedure.

3.2 Stage 2

Where it has not been possible to resolve the complaint via discussion, the Customer Services Department will be informed.  The complaint will be  passed to a senior manager to carry out an investigation. That person will not have had any prior involvement in investigating the complaint.

The complainant will be sent a letter from the Customer Services Department to acknowledge that their complaint has been moved to Stage 2. The target response time is 15 working days.  If more time is needed to complete the investigation, the complainant will be contacted within the 15 working days and informed of what is happening by the Investigating Officer.

The Customer Services department and South Tyneside Safeguarding Children and Adults Partnership Manager should be informed of the outcome of Stage 2.

Should the complainant remain dissatisfied with the outcome of the investigation they can write to the Chief Executive within 28 days, requesting that their complaint is investigated under Stage 3 of the Complaints procedure

3.3 Stage 3

The Chief Executive will appoint a colleague to investigate the complaint on their behalf.  The Investigating Officer will not have had any prior involvement in dealing with the complaint and will not be employed in the service area that is being complained about.  The Customer Services Department will write to the complainant to advise them that their complaint will be investigated at Stage 3 and inform them of the name of the person dealing with it.  The Investigating officer will respond to the complainant directly with their findings. A full response will then be sent to them within 20 working days.  If more time is needed to complete the investigation the complainant will be informed  by the Investigating Officer within the 20 working days.

Should the complainant remain unhappy with the response they can ask the Local Government and Social Care Ombudsman to take up their complaint.

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This chapter provides information for multi-agency practitioners about the roles and responsibilities of partner agencies of the South Tyneside Safeguarding Adults Board.

RELEVANT CHAPTER

South Tyneside Safeguarding Adults Structures and Organisations

1. Introduction

Roles and responsibilities should be clear and collaboration should take place at all the following levels:

  • operational;
  • supervisory line management;
  • practice leadership;
  • strategic leadership within the senior management team;
  • corporate / cross authority;
  • chief officers / chief executives;
  • local authority members and local police and crime commissioners;
  • commissioners;
  • providers of services;
  • voluntary organisations;
  • regulated professionals.

2. Operational Frontline Staff

See also Safeguarding Enquiries Process, Making Safeguarding Personal, Supervision, Safeguarding Training for Staff and Volunteers.

Operational frontline staff are responsible for identifying and responding to allegations of abuse and substandard practice. Staff at operational level need to share a common view of what types of behaviour may be abuse or neglect and what to do as an initial response to a suspicion or allegation that it is or has occurred. This includes GPs. It is the employers and commissioners duty to set these out clearly and reinforce regularly.

It is not for frontline staff to second guess the outcome of an enquiry in deciding whether or not to share their concerns. There should be effective and well publicised ways of escalating concerns where immediate line managers do not take action in response to a concern being raised.

Concerns about abuse or neglect must be reported whatever the source of harm is. It is imperative that poor or neglectful care is brought to the immediate attention of managers and responded to swiftly, including ensuring immediate safety and wellbeing of the adult. Where the source of abuse or neglect is a member of staff it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

There should be clear arrangements in place about what each agency should contribute at this level. These will cover approaches to enquiries and subsequent courses of action. The local authority is responsible for ensuring effective co-ordination at this level.

See also Safeguarding Case Studies.

3. Line Managers’ Supervision

See also Safeguarding Enquiries Process, Making Safeguarding Personal, Supervision, Safeguarding Training for Staff and Volunteers.

Skillful and knowledgeable supervision focused on outcomes for adults is critically important in safeguarding work. Managers have a central role in ensuring high standards of practice and that practitioners are properly equipped and supported. It is important to recognise that dealing with situations involving abuse and neglect can be stressful and distressing for staff and workplace support should be available.

Managers need to develop good working relationships with their counterparts in other agencies to improve cooperation locally and swiftly address any differences or difficulties that arise between front line staff or managers.

They should have access to legal advice when proposed interventions, such as the proposed stopping of contact between family members, or if it is unclear whether proposed serious and / or invasive medical treatment is likely to be in the best interests of the adult who lacks capacity to consent, require applications to the Court of Protection.

4. Practice Leadership

All social workers undertaking work with adults should have access to a source of additional advice and guidance particularly in complex and contentious situations. Principal social workers are often well placed to perform this role or to ensure that appropriate practice supervision is available.

Principal social workers in the local authority are responsible for providing professional leadership for social work practice in their organisation and organisations undertaking statutory responsibilities on behalf of the local authority. Practice leaders / principal social workers should ensure that practice is in line with the Care and Support Statutory Guidance.

Making safeguarding personal represents a fundamental shift in social work practice and underpins all healthcare delivery in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers and senior healthcare safeguarding professionals should have a broad knowledge base on safeguarding and making safeguarding personal and are confident in its application in their own and others’ work.

All providers of healthcare should have in place named professionals, who are a source of additional advice and support in complex and contentious cases within their organisation. There should be a designated professional lead in the ICB, who is a source of advice and support to the governing body in relation to the safeguarding of individuals and is able to act as the lead in the management of complex cases.

All commissioners and providers of healthcare should ensure that staff have the necessary competences and that training in place to ensure that their staff are able to deliver the service in relation to the safeguarding of individuals. Many of the police investigators involved in safeguarding investigations are specially trained for that role and work in specialist units. Each of those units has a set of arrangements to help provide advice and guidance to ensure that a thorough investigation takes place in order to achieve successful outcomes for the individual.

The police service itself has identified ways that enable non-specialist officers to seek advice from supervisors at every stage of the safeguarding process, even when specialist departments are unavailable.

5. Strategic Leadership within the Senior Management Team

Each Safeguarding Adults Board (SAB) member agency – local authority, Integrated Care Board (ICB) and police, should identify a senior manager to take a lead role in the organisational and in inter-agency arrangements, including the SAB.

In order for the SAB to be an effective decision making body providing leadership and accountability, members need to be sufficiently senior within their organisation and have the authority to commit the required resources and able to make strategic decisions.

To achieve effective working relationships, based on trust and transparency, members will need to understand the contexts and restraints within which their counterparts work.

Police forces in England and Wales have a head of public protection who has strategic management responsibility for all aspects of protecting people in vulnerable situations, including adults at risk of, or are experiencing, abuse or neglect. The role of the head of public protection is to build an effective working team and develop a multi-agency approach into alleged offences involving people in vulnerable circumstances. They will also have responsibility for managing and developing policy that ensures standardised processes of investigation and working practice throughout each force. The police and ICBs are represented at a strategic level on every local Safeguarding Adults Board and contact details for the individuals concerned will be available to the SAB and all its members.

6. Corporate / Cross Authority Roles

To ensure effective partnership working, each organisation must recognise and accept its role and functions in relation to adult safeguarding. These should be set out in the Safeguarding Adults Board strategic plan as well as its own communication channels. They should also have protocols for mediation and family group conferences and for various forms of dispute resolution.

7. Chief Officers and Chief Executives

As chief officer for the leading adult safeguarding agency, the Director of Adult Social Services (DASS) has a particularly important leadership and challenge role to play in adult safeguarding including promoting prevention, early intervention and partnership working.

Taking a personalised approach to adult safeguarding requires a DASS promoting a culture that is:

  • person-centred;
  • supports choice and control;
  • aims to tackle inequalities.

However, all officers, including the chief executive of the local authority, NHS and police chief officers and executives should lead and promote the development of initiatives to improve the prevention, identification and response to abuse and neglect.

They need to be aware of and able to respond to national developments and ask searching questions within their own organisations to assure themselves that their systems and practices are effective in recognising and preventing abuse and neglect. The chief officers must sign off their organisation’s contributions to the strategic plan and annual reports.

Chief officers should receive regular briefings of case law from the Court of Protection and the High Courts.

8. Local Authority Member Level

Local authority members need to have a good understanding of the range of abuse and neglect issues that can affect adults and of the importance of balancing safeguarding with empowerment.

They need to understand prevention, proportionate interventions, the dangers of risk averse practice and the importance of upholding human rights.

Some Safeguarding Adults Board include elected members and this is one way of increasing awareness of members and ownership at a political level.

Others take the view that members are more able to hold their officers to account if they have not been party to decision making, though they should always be aware of the work of the SAB.

Managers must ensure that members are aware of any critical local issues, whether of an individual nature, matters affecting a service or a particular part of the community.

Local Authority Health Scrutiny Functions, such as the local authority’s Health Overview and Scrutiny Committee, Health and Wellbeing Boards (HWBs) and Community Safety Partnerships can play a valuable role in assuring local safeguarding measures, and ensuring that the SAB is accountable to local communities. Similarly, local Health and Wellbeing Boards:

  • provide leadership to the local health and wellbeing system;
  • ensure strong partnership working between local government and the local NHS; and
  • ensure that the needs and views of local communities are represented.

HWBs can therefore play a key role in assurance and accountability of the Safeguarding Adults Board, and local safeguarding measures. Equally the Safeguarding Adults Board may on occasion challenge the decisions of HWBs from that perspective.

9. Commissioners

Commissioners from the local authority, NHS and ICBs are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they place contracts with and ensure that those contracts have explicit clauses that holds the providers to account for preventing and dealing promptly and appropriately with any example of abuse and neglect.

10. Providers of Services

All service providers, including housing and housing support providers, should have clear operational policies and procedures that reflect the framework set by the Safeguarding Adults Board in consultation with them.

This should include what circumstances they need to report outside their own chain of line management, including outside their organisation to the local authority.

They need to share information with relevant partners such as the local authority even where they are taking action themselves.

Providers should be informed of any allegation against them or their staff and treated with courtesy and openness at all times. It is of critical importance that allegations are handled sensitively and in a timely way both to stop any abuse and neglect but also to ensure a fair and transparent process. It is in no one’s interests to unnecessarily prolong enquiries. However some complex issues may take time to resolve.

Provider agencies should produce for their staff a set of internal guidelines which relate clearly to the multi-agency policy and which set out the responsibilities of all staff to operate within it. These should include guidance on:

  • identifying adults who are particularly at risk of experiencing abuse or neglect;
  • recognising risk from different sources and in different situations and recognising abusive or neglectful behaviour from other service users, colleagues, and family members;
  • routes for making a referral and channels of communication within and beyond the agency;
  • organisational and individual responsibilities for whistleblowing;
  • assurances of protection for whistleblowers;
  • working within best practice as specified in contracts;
  • working within and co-operating with regulatory mechanisms;
  • working within agreed operational guidelines to maintain best practice in relation to:
    • challenging or distressing behaviour;
    • personal and intimate care;
    • control and restraint;
    • gender identity and sexual orientation;
    • medication;
    • handling of people’s money;
    • risk assessment and management.

Internal guidelines should also explain the rights of staff and how employers will respond where abuse is alleged against them within either a criminal or disciplinary context.

11. Voluntary Organisations

Voluntary organisations need to work with commissioners and the Safeguarding Adults Board to agree how their role fits alongside the statutory agencies and how they should work together. This will be of particular importance where they are offering information and advice, independent advocacy, and support or counselling services in safeguarding situations. This will include telephone or online services. Additionally, many voluntary organisations also provide care and support services, including personal care. All voluntary organisations that work with adults need to have safeguarding procedures and lead officers.

12. Regulated Professionals

Staff governed by professional regulation (for example, social workers, doctors, allied health professionals and nurses) should understand how their professional standards and requirements underpin their organisational roles to prevent, recognise and respond to abuse and neglect.

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Please note: we are currently updating all our documentation to reflect the move to separate Children’s and Adults Partnerships /Boards. The updated Strategic Plan for Safeguarding Adults will appear on this page once it has been signed off and agreed.

See also Safeguarding Posters and Safeguarding Leaflets

 

 

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RELEVANT CHAPTERS

Care and Support Planning

RELEVANT INFORMATION

Supporting Adult Carers (NICE)

Social Work Practice with Carers (Research in Practice for Adults)

Quick Guide: Supporting People who Provide Unpaid Care for Adults with Health or Social Care Needs (NICE and SCIE)

see also  Support for Carers, South Tyneside Council

September 2022: Links to the following guidance for workers supporting carers have been added:

  • Social Work Practice with Carers (Research in Practice for Adults)
  • Quick Guide: Supporting People who Provide Unpaid Care for Adults with Health or Social Care Needs (NICE and SCIE)

1. Introduction

Carers, in this context, are usually family members or a friends.

Carers can play an important role in preventing and detecting abuse and neglect of the people they care for.  The vast majority of carers strive to act in the best interests of the person they support. There are times, however, when carers may themselves experience abuse from the person to whom they are offering care and support or from the local community in which they live.

Risk of harm to the supported person may also arise because of carer stress, tiredness, or lack of information, skills or support. Also, there may be times where the harm caused is deliberate.

Circumstances in which a carer could be involved in a situation that may require a safeguarding response from agencies include:

  • a carer may witness or talk about abuse or neglect in relation to the adult they care for, or another person;
  • a carer may experience intentional or unintentional harm from the adult they are supporting, or from professionals and organisations they are in contact with;
  • a carer may harm or neglect the adult they support on their own or with others. This may, or may not, be deliberate.

Where there is intentional abuse, adult safeguarding under the Care Act should always be considered.

All staff and professionals should support a human rights based approach to issues of abuse and neglect and to the recognition and support of carers.

Work developed by the Association of Directors of Adult Social Services (ADASS), carers groups, commissioners and organisations working with carers, identify six distinct areas related to carers and safeguarding:

  • partnership working;
  • prevention;
  • support;
  • information and advice;
  • advocacy;
  • role of carers in strategic planning.

2. Partnership Working

Carers have a wealth of information and knowledge about the person that they support. As well as raising concerns, carers are able to support safeguarding enquiries by sharing information and are valued partners in such enquiries. Their views may hold the key to protecting people. If a carer speaks up about abuse or neglect, it is essential that they are listened to and appropriate enquiries made carers may identify and mitigate risk and act as advocates. The lessons from Transforming Care (Local Government Association) and other public inquiries need to be taken forward in viewing carers as equal partners unless there are valid reasons not to.

Where the adult lacks capacity, carers may reasonably provide professionals with the outcome they consider the adult at risk would want, as they know the persons likes and dislikes, what relationships are important to them and what relationships they may find difficult. Consideration for the carer and adult in safeguarding plans, in for example family conferences that have their own dynamics, need to take into account conflicting views as carers may not want the same outcome as the adult they are supporting (see the chapter on Stage 3: Plan / Review).

3. Support

‘If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to whether, as part of the assessment and support planning process for the carer and, or, the adult they care for, support can be provided that removes or mitigates the risk of abuse.’ (Chapter 14, Care and Support Statutory Guidance).

See also Support for Carers, South Tyneside Council

3.1 Information and Advice

See also Information and Advice chapter.

Carers need to know how they can find support and services available in their area, and be able to access advice, information. Carers need to know, that they can raise a concern in a safe environment and be confident that their concerns will be acted upon. It might be that people are unaware that the actions that they take could be perceived by others as abusive. For example, someone with a learning disability entitled to state benefits to meet their living expenses, and to have money as part of their access to leisure and other personal requirements may have this controlled by a family member.

Carers should have access to information and advice in a way that is meaningful to them and may themselves be in need of care and support and need to know how they can access services. See also Support and Care for Adults, South Tyneside Council.

3.2 Assessments

The Care Act includes protection from abuse and neglect as part of the definition of wellbeing (see Promoting Wellbeing chapter). As such, a needs assessment for the carer’s assessment is an important opportunity to explore the individuals’ circumstances and consider whether it would be possible to provide information or support that prevents abuse or neglect from occurring. This may be for example, by providing training to the carer about the condition that the adult they care for has, or to support them to care more safely. Where that is necessary the local authority should make arrangements for providing such interventions.

The carer’s assessment is distinct from a needs assessment. Safeguarding should always be at the forefront of assessments. Professionals need to be candid with carers about the risks that a carer’s assessment may identify for either preventing the need for safeguarding to them, or preventing the risk of the carer abusing the person that they are caring for.

Whole family assessments might also be considered using the framework of Think Family as an appropriate way forward. Working collaboratively with other agencies, carers may also receive support from a number of agencies.

4. Safeguarding Enquiries

If a carer raises any issues about abuse or neglect, it is essential that they are listened to and that, where appropriate, a safeguarding enquiry is undertaken and other agencies are involved as required.

Families, who view individual benefits as part of the family income, may not view their actions as abusive, but where the adult they are supporting has little or no choice about how their money is spent, this could be seen as financial abuse by others.  Where carers may have acted in a way that constitutes abuse staff should respond according to adult safeguarding procedures so that the adult is safeguarded appropriately. Whilst there may be mitigating circumstances to take into consideration the wellbeing and safety of the adult should be paramount.

If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:

  • removing or reducing risk – whether, as part of the assessment and support planning process for the carer and / or the adult they care for, support can be provided that removes or reduces the risk of abuse. This may include, for example, the provision of training, information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy (see Independent Advocacy chapter); in others, a carer may benefit from having such support if they are under great stress;
  • involving other agencies – whether other agencies should be involved: in some circumstances where it is possible a criminal offence has been committed this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring the situation.

Other key considerations for carers should include:

  • involving carers in safeguarding enquiries relating to the adult they care for, as appropriate;
  • whether or not a joint assessment of the adult and the carer is appropriate in each individual circumstance;
  • the risk factors that may increase the likelihood of abuse or neglect occurring;
  • whether a change in circumstance changes the risk of abuse or neglect occurring.

A change in circumstance should also trigger the review of the care and support plan and, or, support plan (see Care and Support Planning chapter).

5. Advocacy

In some instances, the most appropriate person to support the adult and act as an advocate is the primary carer. Where the carer is acting in the role of advocate, they may need support to do so, therefore professionals need to provide information and ensure that it is understood. The carer themselves may be in need of an advocate. For example, where there are safeguarding concerns about an older person with their own care and support needs caring for a partner with dementia. Assumptions should not be made about carers acting as advocates or being in need of advocacy and each case should take account of the personal circumstances.

Advocacy can be helpful in all kinds of situations when the adult or their carer is finding it difficult to have their opinions and choices heard. There are numerous advocacy services that can offer support depending on the individual’s circumstance and the outcomes they wish to achieve.

Community Advocacy services refers to all advocacy that is not a legal entitlement and offers support with a range of situations. Organisations such as POhWER, SEAP and VoiceAbility can all offer further advice.

Advocacy for a specific cause is offered by charities and organisations which can provide advocacy for a specific issue. Examples include Shelter who offers advocacy for people experiencing housing problems and Coram Voice who offers mental health advocacy for young people in care.

Group advocacy (also known as collective advocacy) is where a group of people with similar experiences meet to support each other and collectively strengthen their voice. Mental health charities, like the National Survivor User Network for Mental Health (NSUN), has a network of mental health service user groups across the UK, as well as Mind and Mind’s Infoline.

Peer advocacy: Peer advocates have lived experience of a mental health problem and can offer support to help adults cope with a range of problems.

Statutory advocacy offers a legal entitlement to advocacy in certain circumstances. There are three types of statutory advocates in England and Wales: Independent Mental Health Advocates (IMHAs), Independent Mental Capacity Advocates (IMCAs) and advocates supporting people under the Care Act 2014.  See Independent Advocacy for further information.

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This chapter provides information for multi-agency practitioners about the duty the local authority has in protecting property and pets of adults who are being cared for away from their own home.

RELEVANT CHAPTER

Mental Capacity

RELEVANT INFORMATION

Chapter 10, Care and Support Planning, Care and Support Statutory Guidance (Department of Health and Social Care) 

Guidance on Dog Control and Welfare for Police and Local Authorities

Code of Practice for the Welfare of Dogs (Department for Environment, Food and Rural Affairs) 

Code of Practice for the Welfare of Cats (Department for Environment, Food and Rural Affairs)

Code of Practice for the Welfare of Privately Kept Non-Human Primates (Department for Environment, Food and Rural Affairs) 

The local authority must take all reasonable steps to protect the movable property of an adult with care and support needs who is being cared for away from home, in a hospital or in accommodation such as a care home, and who cannot arrange to protect their property themselves; this could include their pets as well as their personal property (for example, private possessions and furniture). The local authority must act where it believes that if it does not take action there is a risk of movable property being lost or damaged.

Protecting property may include arranging for pets to be looked after when securing premises for someone who is having their care and support needs provided away from home in a care home or hospital, and who has not been able to make other arrangements for the care of their home or pets.
In order to protect movable property in these circumstances the local authority may enter the property, at reasonable times, with the adult’s consent, ideally in writing; but reasonable prior notice to enter should be given.

If the adult lacks the capacity to give consent to the local authority entering the property, consent should be sought from a person authorised under the Mental Capacity Act 2005 (MCA) to give consent on the adult’s behalf. This might be:

  • an attorney (also known as a donee with lasting power of attorney) that is someone appointed under the MCA who has the legal right to make decisions (for example decisions about their care and support) within the scope of their authority on behalf of the person (the donor) who made the power of attorney;
  • a deputy (also known as a court appointed deputy) that is a person appointed by the Court of Protection under the MCA, to take specified decisions on behalf of someone who lacks capacity to take those decisions themselves;
  • the Court of Protection.

If the adult in question lacks capacity and no other person has been authorised to act on their behalf, the local authority must act in the best interests of the adult (see Mental Capacity).

If a third party tries to stop an authorised entry into the home they will be committing an offence, unless they can give a good reason for why they are obstructing the local authority in protecting the adult’s property. Committing such an offence could, on conviction by a Magistrates’ Court, lead to the person being fined. If a local authority intends to enter a home then it must give written authorisation to an officer of the council and that person must be able to produce it if asked for.

The local authority has no power to apply for a warrant to carry out their duties to protect property. If the Court decides the obstruction is reasonable then the local authority would have no power to force entry.

This duty on the local authority lasts until the adult in question returns home or makes their own arrangements for the protection of property or until there is no other danger of loss or damage to property; whichever happens first. Often a one off event is required such as the re-homing of pets or ensuring that the property is secured.

If costs are incurred or if there are ongoing costs the local authority can recover any reasonable expenses they incur in protecting property under this duty from the adult whose property they are protecting.

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This chapter provides information for multi-agency practitioners in relation to gaining access to adults who are experiencing, or at risk of, abuse or neglect. Only the police are legally allowed to enter premises without permission, in situations that meet specific criteria. The local authority has a number of legal options they can pursue where access to an adult is being denied. Where practitioners from partner agencies have concerns they should first speak to their line manager / designated safeguarding lead, who will decide whether a safeguarding referral is warranted.

RELEVANT CHAPTER

Stage 1: Concerns

RELEVANT GUIDANCE

Gaining access to an adult suspected to be at risk of neglect or abuse: a guide for social workers and their managers in England, SCIE.

1. Introduction

This chapter provides information on legal options for gaining access to adults who are experiencing or at risk of abuse or neglect, where access is restricted or denied. Section 47 of the National Assistance Act 1948 which gave a local authority power to remove a person in need of care from home has been replaced by the Care Act 2014.

2. Safeguarding Enquiries

Local authorities have a duty to make, or cause to be made, enquiries in cases where they reasonably suspect that an adult with care and support needs is experiencing or is at risk of abuse or neglect, and as a result of those needs, is unable to protect themselves from the actual or potential risk.

This duty does not provide for a power of entry, or right of unimpeded access to the adult who is subject to such an enquiry. There are, however, a range of existing legal powers which are available to gain access, where required.

Whether legal intervention is required, and if so which powers would be the most suitable, will always depend on the individual circumstances of the case. The local authority can apply to the courts or seek assistance from the police to gain access in certain circumstances.

3. Difficulty in Gaining Access

Reasons why it may be difficult to gain access to a person who is the subject of an adult safeguarding enquiry may include:

  1. access to the premises denied by a person who is present, usually a family member, friend or informal carer;
  2. access to the premises is given, but it is not possible to speak to the adult alone because a family member, friend or informal carer insists on being present;
  3. the adult themselves (whether or not they are unduly under the influence of the person present) is insisting that the person is present. In such cases if the adult is known to have mental capacity, the issue of access in terms of the law does not apply.

Where access is refused, it should not automatically lead to consideration of the use of legal powers. Attempts should first be made to resolve the situation via negotiation and a professional relationship based on trust; sensitive handling by skilled practitioners may satisfactorily resolve the situation.

If negotiation is not successful, the local authority must consider whether denial of access is unreasonable and whether the concerns justify intervention. This should involve a discussion with the social worker, manager and legal department regarding the level of safeguarding concern, perceived risks, and possible outcomes of both intervening and not intervening. If it is decided that using legal powers is justified, it should be decided which powers would be the most appropriate.

All such discussions and considerations should be fully recorded including objective facts and professional assessment so that the basis of all decision making is clearly based on objective fact, assessment of risk and proportionate action (see Case Recording chapter).

Unlawful intervention could not only have a detrimental effect on the adult concerned, and their carer / family, but also lead to judicial criticism and / or liability to compensation.

4. Proportionality

Where it is decided that the use of any power to gain entry is justified, it should be exercised proportionately, in relation to the risk and the level of safeguarding concern for the adult.

An emergency situation involving significant risk may justify the use of legal powers – such as police entry to save life and limb – where there is insufficient time to negotiate gaining access.

The principle of the least restrictive option helps to ensure that interventions are necessary and proportionate.

In relation to a person who lacks mental capacity, consideration must be given to achieving their best interests using an approach which is least restrictive of the person’s rights and freedom of action (see Independent Mental Capacity Advocates and Independent Mental Health Advocates).

5. Gaining Access

The SCIE guidance for social workers Gaining access to an adult suspected to be at risk of neglect or abuse notes the following legal powers may be considered by the local authority to gain access to the person experiencing, or at risk of, abuse or neglect. The following legal powers may be relevant, depending on the circumstances:

  • If the person has been assessed as lacking mental capacity in relation to a matter relating to their welfare: the Court of Protection has the power to make an order under Section 16(2) of the MCA relating to a person’s welfare, which makes the decision on that person’s behalf to allow access to an adult lacking capacity. The Court can also appoint a deputy to make welfare decisions for that person.
  • If an adult with mental capacity, at risk of abuse or neglect, is impeded from exercising that capacity freely: the inherent jurisdiction of the High Court enables the Court to make an order (which could relate to gaining access to an adult) or any remedy which the Court considers appropriate (for example, to facilitate the taking of a decision by an adult with mental capacity free from undue influence, duress or coercion) in any circumstances not governed by specific legislation or rules.
  • If there is concern about a mentally disordered person: Section 115 of the MHA provides the power for an approved mental health professional (approved by a local authority under the MHA) to enter and inspect any premises (other than a hospital) in which a person with a mental disorder is living, on production of proper authenticated identification, if the professional has reasonable cause to believe that the person is not receiving proper care.
  • If a person is believed to have a mental disorder, and there is suspected neglect or abuse: Section 135(1) of the MHA, a magistrates court has the power, on application from an approved mental health professional, to allow the police to enter premises using force if necessary and if thought fit, to remove a person to a place of safety if there is reasonable cause to suspect that they are suffering from a mental disorder and (a) have been, or are being, ill-treated, neglected or not kept under proper control, or (b) are living alone and unable to care for themselves.
  • Power of the police to enter and arrest a person for an indictable offence: Section 17(1)(b) of PACE.
  • Common law power of the police to prevent, and deal with, a breach of the peace. Although breach of the peace is not an indictable offence the police have a common law power to enter and arrest a person to prevent a breach of the peace.
  • If there is risk to life and limb: Section 17(1)(e) of PACE gives the police the power to enter premises without a warrant in order to save life and limb or prevent serious damage to property. This represents an emergency situation and it is for the police to exercise the power).
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.RELEVANT GUIDANCE

 Achieving Best Evidence in Criminal Proceedings: Guidance on interviewing victims and witnesses, and guidance on using special measures (Ministry of Justice)

1. Introduction

Everyone is entitled to be protected by the law and have access to justice. Although the local authority has the lead in making enquiries in adult safeguarding cases, where criminal activity is suspected involving the police as soon as possible is likely to be beneficial in many cases.

Behaviour which amounts to abuse and neglect also often constitute specific criminal offences under various legislation, for example:

  • physical or sexual assault or rape;
  • psychological abuse or hate crime;
  • wilful neglect;
  • unlawful imprisonment;
  • theft and fraud;
  • certain forms of discrimination.

See Safeguarding Case Studies

For the purpose of a court trial, a witness is deemed to be competent if they can understand the questions and respond in a way that the court can understand. Police have a duty to assist witnesses who are vulnerable and intimidated.

2. Special Measures

A range of special measures are available to aid gathering and giving of evidence by vulnerable and intimidated witnesses.

These should be considered from the onset of a police investigation, and can include:

  • an immediate referral from adult social care or other concerned agency
  • discussion with the police will enable the police to establish whether a criminal act has been committed. This will give an opportunity to determine if, and at what stage, the police need to become involved further and undertake a criminal investigation;
  • the police have powers to take specific protective actions, such as Domestic Violence Protection Orders (DVPO);
  • as a higher standard of proof is required in criminal proceedings (‘beyond reasonable doubt’) than in disciplinary or regulatory proceedings (where the test is the balance of probabilities), so early contact with the police may help to  obtain evidence and witness statements;
  • early involvement of the police helps to ensure that forensic evidence is not lost or contaminated;
  • police officers need to have considerable skill in investigating and interviewing adults with different disabilities and communication needs, in order to prevent the adult being interviewed unnecessarily on other occasions. Research has found that sometimes evidence from victims and witnesses with learning disabilities is discounted. This may also apply to others such as people with dementia. It is crucial that reasonable adjustments are made and appropriate support given, so everyone can have equal access to justice;
  • police investigations should be coordinated with health and social care enquiries but  may take priority. The local authority’s duty to ensure the wellbeing and safety of the person continues throughout a criminal investigation;
  • appropriate support during the criminal justice process should be available from local organisations such as Victim Support and court preparation schemes;
  • some witnesses will need protection from the accused or their associates (see Section 3, Adults Witnesses who are Vulnerable or Intimidated, below);
  • the police may be able to arrange support for victims.

Special Measures were introduced in the Youth Justice and Criminal Evidence Act 1999 and include a range of interventions to support witnesses to give their best evidence and to help reduce anxiety when attending court. These include the use of screens around the witness box, the use of live (video) link or recorded evidence and the use of an intermediary to help witnesses understand the questions they are being asked and to give their answers accurately.

3. Adult Witnesses who are Vulnerable or Intimidated

Adults who are deemed as vulnerable witnesses have:

  • a mental health disorder;
  • a learning disability; and / or
  • a physical disability.

These witnesses are only eligible for special measures if the quality of the evidence that will be given by them is likely to be diminished because of their disorder or disability.

Intimidated witnesses are those whose quality of evidence is likely to be diminished because of fear or distress. In deciding whether a witness comes into this category the court takes account of:

  • the nature and alleged circumstances of the offence;
  • the age of the witness;
  • the social and cultural background and ethnic origins of the witness;
  • the domestic and employment circumstances of the witness;
  • any religious beliefs or political opinions of the witness;
  • any behaviour towards the witness by the accused or third party.

Also coming into this category are:

  • complainants in cases of sexual assault;
  • witnesses to specified gun and knife offences;
  • victims of and witnesses to domestic abuse, racially motivated crime, crime motivated by reasons relating to religion, homophobic crime, gang related violence and repeat victimisation;
  • those who are older and frail;
  • the families of murder victims.

Registered Intermediaries (RIs) help communicate with vulnerable witnesses during the criminal justice process.

As noted above, a criminal investigation by the police takes priority over all other enquiries.

However a multi-agency approach should be agreed, to ensure that the interests and personal wishes of the adult are considered throughout, even if the adult decides not  to provide any evidence or support a prosecution.

The welfare of the adult. and others including children, is paramount and requires continued risk assessment to ensure the outcome is in their interests and enhances their wellbeing.

If the adult has the mental capacity to make informed decisions about their safety and they do not want any action to be taken, this does not prevent information being shared with relevant colleagues. This enables all professionals to assess the risk of harm and be confident that the adult is not being unduly influenced, coerced or intimidated and is aware of all the options available to them. This will also enable professionals to share decision making and risk management to ensure that decisions made are safe and valid. The adult should be informed of this action unless doing so would increase the risk of harm to them.

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This chapter provides information for multi-agency practitioners in relation to adults with care and support needs where there are one or more local authorities involved. It also outlines the principles of out of area arrangements, by which the local authorities should abide.

RELEVANT CHAPTER

Ordinary Residence

See also Cross Border Placements case studies

1. Introduction

There is increased complexity in service provision arrangements for adults with care and support needs when they occur across local authority borders. Difficulties may arise where funding or commissioning responsibilities are held by one authority, but concerns about potential abuse or neglect arise in another authority area.

The following terms are used in this chapter:

  • Placing authority: the local authority or NHS body that has commissioned the service for an individual involved in a safeguarding adults allegation.
  • Host authority: the local authority or NHS body in the area where the abuse occurred.

2.  Principles for Out of Area Safeguarding Adult Arrangements

The host authority should take overall responsibility for coordinating the safeguarding adults enquiry and ensure there is effective communication between all agencies and professionals involved in the case, including meetings held and planning for any required investigation.

The placing authority should:

  • have a continuing duty of care to the adult that they have placed;
  • participate in the investigation as required;
  • ensure that the provider has arrangements and procedures in place in relation to safeguarding adults and how staff should respond to concerns, which should also link to the local (host) multi-agency safeguarding adults procedures. This should be a requisite of contracting arrangements. This should include the requirement to inform the host authority of any safeguarding concerns.

Authorities may negotiate certain arrangements, for example relating to another authority undertaking assessments, reviews, investigative activities. In such cases, the placing authority would maintain overall responsibility for the adult they placed. Reimbursement for such actions should be discussed and agreed between the authorities, as appropriate.

Providers of care and support services have rights and responsibilities, and also may be required to undertake their own investigations into an adult safeguarding concern. The host authority must ensure effective and timely communication with the provider throughout the investigation (see also Integration, Cooperation and Partnerships).

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This chapter provides outline information for practitioners on what to do if they have a concern about an adult outside of office hours.

1. Making a Safeguarding Referral to the Local Authority

When an adult is experiencing, or at risk of abuse or neglect but there is no immediate risk of harm, the practitioner should follow their own local processes for raising concerns. This could either mean they contact the local authority safeguarding adults team themselves or they share their concerns with the safeguarding adults lead in their organisation, who will then make the referral to the local authority safeguarding adults team.

However, if there is concern that immediate action is required or there is an urgent risk, a referral should be made to the South Tyneside Safeguarding Adults Out of Hours Team without delay (see Local Contacts). Where it is suspected a crime has been committed the police should also be contacted.

Details of all actions taken should be recorded on the adult’s case file / record.

2. Taking Immediate Action to Protect an Adult

If the Out of Hours Team receives a referral which indicates there is an immediate or urgent risk to the adult, the worker receiving the referral must take all steps necessary to protect the adult. This includes arranging emergency medical treatment, contacting the police (by telephoning 999) and taking any other action to ensure the adult is safe.

3. Case Recording and Handover

The Out of Hours Team worker should record details of the concerns on the adult’s electronic social care record. The worker will pass all necessary information to the relevant team in adult social care before the end of their shift. If the adult is already known to the local authority, the out of hours worker will notify their allocated worker.

See also Case Recording.

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RELEVANT CHAPTERS

South Tyneside Multi Agency Information Sharing Agreement

Case Recording

RELEVANT INFORMATION

UK GDPR Guidance and Resources (Information Commissioner’s Office)

Data Protection and Working from Home (Information Commissioner’s Office) 

1. Introduction

Data protection legislation should not be seen as an obstacle to sharing information, but as a framework of best practice which helps to ensure that when the local authority uses, records and shares information it does so safely and in a way which is transparent and in line with the law.

Partner agencies of the South Tyneside Safeguarding Adults Board collect, store, use and retain (for specified time periods) information about people with whom they work. This includes:

  • adults who use (or previously used) their services, including their families and any children;
  • staff; and
  • suppliers.

When processing data in this way, organisations must comply with the requirements of the Data Protection Act 2018 (DPA) and the UK General Data Protection Regulation (UK GDPR).

Organisations must also ensure through their procedures and working practices, that all employees, contractors, consultants, suppliers and partners who have access to any personal data held by or on behalf of the organisation are fully aware of and abide by their duties and responsibilities under data protection legislation. Any contracts with service providers must be clear about the different parties’ responsibilities for data processing and information sharing.

Personal information must be handled and dealt with in accordance with data protection legislation however it is collected, stored, recorded and used, and whether it be on paper, on computer or digital records or recorded in any other way.

Organisations may also be required to collect and use information in order to comply with the requirements of central government, such as in the case of a Safeguarding Adults Review or Care Quality Commission inspection.

2. Legislation

2.1 Data Protection Act 2018

The Data Protection Act 2018 (DPA)  aims to ensure that UK data protection legislation keeps pace with technological changes, and the impact these have had on the collection and use of personal data.

2.2 UK General Data Protection Regulation

The UK General Data Protection Regulation (UK GDPR) sets out the key principles, rights and obligations for processing personal data. For more information see, UK GDPR: Guidance and Resources, Information Commissioner’s Office.

The GDPR:

  • gives individuals greater control of their data by improving consent processes; and
  • introduced the ‘right to be forgotten’ which enables the data subject to have their data ‘forgotten’ in certain circumstances.

If staff receive a query about the collection or processing of personal data, they should contact their Information Governance team / Data Protection Lead for advice.

3. Principles of Data Protection: Article 5 DPA

Anyone processing personal data must comply with the principles laid down the DPA and UK GDPR. These are legally enforceable and require that when personal data is processed (see also Section 3.2 What is personal data under Article 4?) it must be:

  • lawful and fair and carried out in a transparent manner in relation to the data subject. (lawfulness, fairness and transparency principle);
  • specified, explicit and legitimate and not further processed for other purposes incompatible with those purposes (purpose limitation principle);
  • adequate, relevant and not excessive to what is necessary in relation to the purposes for which data is processed (the data minimisation principle);
  • accurate and kept up to date (the accuracy principle);
  • kept for no longer than is necessary for the purposes for which the personal data is processed (the storage limitation principle); and
  • stored in a way that ensures appropriate security including protection against unauthorised or unlawful processing and accidental loss, destruction or damage, using appropriate technical or organisational measures (the integrity and confidentiality principle and the accountability principle).

3.1 Handling personal data and or sensitive personal data

The DPA outlines conditions for the processing of personal data, and makes a distinction between personal data and sensitive personal data.

Personal data is is any information relating to a living person who can be identified or who is identifiable, directly from that information, or who can be indirectly identified from that information in combination with other information

3.2 What is Personal Data under Article 4 GDPR?

Personal data is:

  • any information relating to an identified or identifiable natural person such as:
    1. a name;
    2. an identification number;
    3. location data;
    4. an online identifier such as an IP address or cookies; or
    5. an email address.

3.3 Special Categories of Data (sensitive personal data): GDPR Article 9

Special category data is personal data that needs more protection because it is sensitive. It includes personal data which reveals:

  • racial or ethnic origin;
  • political opinion;
  • religious or other beliefs;
  • trade union membership;
  • physical or mental health or condition;
  • sexual life or sexual orientation.

3.4 Identifying a lawful basis for sharing information 

Article 6 of the UK GDPR providers practitioners with a number of lawful bases for sharing information. At least one of these must apply whenever personal data is processed.

Where practitioners need to process and share special category data (sensitive personal data), they need to identify both a lawful basis for processing under Article 6 of the UK GDPR and a special category condition for processing in compliance with Article 9 (see: Information Commissioner’s Office, Lawful basis for processing);

4. Data Protection Practice

The organisation must:

  • observe fully conditions regarding the fair collection and use of personal information;
  • meet its legal obligations to specify the purpose for which information is used;
  • collect and process appropriate information and only to the extent that it is needed to fulfil operational needs or to comply with any legal requirements;
  • ensure the quality of information used;
  • apply strict checks to determine the length of time information is held;
  • take appropriate technical and organisational security measures to safeguard personal information;
  • ensure that personal information is not transferred abroad without suitable safeguards;
  • ensure that the rights of people about whom the information is held can be fully exercised under data protection legislation. These include:
    • the right to be informed that processing is being undertaken;
    • the right of access to one’s personal information within the statutory timescale;
    • the right to prevent processing in certain circumstances;
    • the right to correct, rectify, block or erase information regarded as wrong information.

In addition, the organisation should ensure that:

  • there is someone with specific responsibility for data protection;
  • everyone managing and handling personal information understands that they are contractually responsible for following good data protection practice;
  • everyone managing and handling personal information is appropriately trained to do so;
  • everyone managing and handling personal information is appropriately supervised;
  • anyone wanting to make enquiries about handling personal information, whether a member of staff or a member of the public, knows what to do;
  • queries about handling personal information are promptly and courteously dealt with;
  • methods of handling personal information are regularly assessed and evaluated;
  • performance with handling personal information is regularly assessed and evaluated;
  • data sharing is carried out under a written agreement, setting out the scope and limits of the sharing. Any disclosure of personal data will be in compliance with approved procedures.

All employees should be aware of their organisation’s data protection policy and of their duties and responsibilities under the DPA.

All managers and staff will take steps to ensure that personal data is kept secure at all times against unauthorised or unlawful loss or disclosure and in particular will ensure that:

  • paper files and other records or documents containing personal / sensitive data are kept in a secure environment;
  • personal data held on computers and computer systems is protected by the use of secure passwords, which where possible have forced changes periodically;
  • passwords must not be easily compromised and must not be shared with others;
  • personal data must only be accessible to team members with appropriate access levels;
  • data in all forms must be disposed of by secure means in accordance with local policies.

All contractors, consultants, suppliers and partners must:

  • ensure that they and all of their staff who have access to personal data held or processed for or on behalf of the organisation, are aware of this policy and are fully trained in and are aware of their duties and responsibilities under data protection legislation. Any breach of any provision of the legislation will be deemed as being a breach of any contract between the organisation and that individual, partner or firm (see Report a Breach, Information Commissioner’s Office);
  • allow data protection audits by the organisation of data held on its behalf (if requested);
  • indemnify the organisation against any prosecutions, claims, proceedings, actions or payments of compensation or damages, without limitation.

All contractors and suppliers who use personal information supplied by the organisation will be required to confirm that they abide by the requirements of data protection legislation in relation to such information supplied by the organisation.

The organisation must also:

  • ensure data subjects are given greater control of their data by improving consent processes. Consent must be freely given, specific, informed and give a clear indication of their wishes. This must be provided by a statement or clear affirmative action, signifying the individual’s agreement to the processing of their personal data;
  • ensure that data subjects have the ‘right to be forgotten’ in certain circumstances;
  • keep a record of data operations (mapping data flow within the organisation) and activities and assess if it has the necessary data processing agreements in place, and take action to remedy if not;
  • carry out data protection impact assessments (DPIAs) on its products and systems;
  • designate a data protection officer (DPO);
  • review processes for the collection of personal data;
  • be aware of the duty to notify the Information Commissioner’s Office (ICO) of a data breach (the relevant supervisory authority);
  • ensure ‘privacy by design’ and ‘privacy by default’ in new products (such as a case new recording system) and assess whether existing products used by the organisation meets the new data protection standards and take action accordingly to ensure compliance.

5. Redaction of Third Party Data

Before sharing information, personal data relating to third parties must be redacted (removed) in order to protect their privacy. For example, where case records include references to other people, such as the adult’s family and friends, it is likely some of this information will need to be withheld (redacted) before the record can be shared.

Under the Data Protection Act, it is for each organisation to weigh up how ‘reasonable’ it is to share another person’s information in each case (for example it may be reasonable to share information about another family members’ health condition if is likely to be hereditary). The Act is clear however that any person who appears in records because they were employed to provide care or received payment for providing a service, or acted in an official capacity, should not be treated as ‘third party’. This means that the names and information of social workers and other professionals should not be redacted from case records.

6. Rights of the Data Subject

Any person whose information is being processed has the following rights:

  • to be informed of data processing (for example a privacy notice);
  • to be able to access information free of charge (also known as a subject access request) – there is a one month time limit for an organisation to respond to any such request;
  • to have inaccuracies corrected;
  • to have information erased (although this is not an absolute right);
  • to restrict processing;
  • to have data portability;
  • intervention in respect of automated decision making;
  • to be able to withdraw consent;
  • to complain to the Information Commissioner’s Office (ICO).

6.1 Right to be informed (Section 44 DPA)

A person whose information is being processed should have access to a privacy notice, setting out:

  • lawful basis for processing;
  • contact details for the Data Protection Officer (DPO);
  • what information will be processed;
  • who it will be shared with and why;
  • how long it will be held;
  • details of rights;
  • how to complain.

6.2 Rectification (Section 46 DPA)

A person whose information is being processed has the following rights:

  • to rectify or correct inaccurate information;
  • if information is incomplete it must be completed;
  • rectification or correction can be achieved by the provision of a supplementary statement;
  • where the rectification is of information maintained for the purposes of evidence, instead if rectifying, the processing should be restricted;
  • be informed in writing if request has been granted and if not the reasons for this.

7. Action if there is a Data Breach

A breach of data security can be either accidental, deliberate or unlawful and can involve:

  1. destruction;
  2. loss;
  3. alteration;
  4. unauthorised disclosure;
  5. unauthorised access.

A breach covers accidental and deliberate causes and is more than just losing personal data.

7.1 Examples of data breaches

These are commonly occurring breaches:

  • access by an unauthorised party, including a third party;
  • deliberate or accidental action (or inaction) by a controller or processor;
  • sending personal data to an incorrect recipient;
  • computing devices containing personal data being lost or stolen;
  • alteration of personal data without permission; and
  • loss of availability of personal data.

7.2 What constitutes a serious data breach?

A serious data breach:

  • is where it is likely to result in a risk to the rights and freedoms of individuals. If unaddressed such a breach is likely to have a significant detrimental effect on individuals – for example, result in discrimination, damage to reputation, risk of physical harm, financial loss, loss of confidentiality or any other significant economic or social disadvantage;
  • must be assessed on a case by case basis;
  • must consider these factors: detriment / nature of data / volume (detriment includes emotional distress as well as both physical and financial damage).

All serious data breaches must be reported to the ICO within 72 hours of becoming aware of the breach. See ICO for further information.

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CARE ACT 2014

Following the needs and carer’s assessment and determination of eligibility, a care and support plan (for an adult with care and support needs) or a support plan (for a carer) must be provided where a local authority meets a person’s needs.

RELEVANT CHAPTERS

Promoting Wellbeing

Preventing, Reducing or Delaying Needs

RELEVANT INFORMATION

Culturally Appropriate Care (Care Quality Commission) 

September 2021: This chapter has been amended to add a link to Culturally Appropriate Care published by the Care Quality Commission, as above.

Care and support should put people in control of their care, with the support that they need to enhance their wellbeing and improve their connections to family, friends and community. A vital part of this process for people with ongoing needs which the local authority is going to meet is the care and support plan, or the support plan in the case of carers.

The guiding principles in the development of the plan are that the process should be person centred and person led, in order to meet the needs and achieve the outcomes of the person in ways that work best for them as an individual or as part of a family.

The process and the outcomes should be built holistically around:

  • people’s wishes and feelings;
  • their needs;
  • values and aspirations.

These principles apply irrespective of the extent to which the person chooses or is able to actively direct the process.

Consideration of needs should also include the extent to which the needs or a person’s other circumstances may mean that they are at risk of abuse or neglect. The planning process may bring to light new information that suggests a safeguarding issue, and therefore lead to a requirement to carry out a safeguarding enquiry (see Safeguarding Enquiries Process). Where such an enquiry leads to further specific interventions being put in place to address a safeguarding issue, these  should  be included in the care and support plan.

Each partner in the plan should be clear about their role. For example, the person may need help to weigh up different service options to understand what each involves and to be able to choose the most appropriate and least restrictive option possible.

In some circumstances it may not be appropriate to jointly prepare the plan. For example, a person may not wish their family to be involved, the authority may be aware that family members may have conflicting interests, or the person may have asked the local authority to prepare the plan with someone who lives far away from the person and even with the assistance of email, phone and other methods of communication is unable to prepare the plan in a timely fashion.

The test for allowing the person and others to prepare the plan jointly with the local authority should start with the presumption that the person at the heart of the care plan should give consent for others to do so.

Safeguarding principles must be included in order to ensure that there is no conflict of interest between the person and the third party they wish to involve to prepare the plan jointly with (see Safeguarding: What is it and Why does it Matter?)

Where a person lacks capacity and cannot consent to third parties jointly preparing the plan, the local authority must always act in the best interests of the person requiring care and support.

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1. Introduction

The Care Act 2014 sets out the local authority’s functions and responsibilities for care and support. Sometimes external organisations may be better placed than the local authority itself to carry out some of these functions. For instance, an outside organisation might specialise in carrying out assessments or care and support planning for certain disability groups, where the local authority does not have the in-house expertise. External organisations may also be able to provide additional capacity to carry out care and support functions.

The Care Act allows local authorities to delegate some, but not all, of their care and support functions to other parties. This power is intended to allow flexibility for local approaches to be developed in delivering care and support, to allow local authorities to work more efficiently and innovatively and provide better quality care and support to local populations.

As with all care and support, individual wellbeing should be central to any decision to delegate a function. Local authorities should not delegate its functions simply to gain efficiency where this is to the detriment of the wellbeing of people using care and support.

2. Local Authority Responsibility

When a local authority delegates any of its functions, it still retains ultimate responsibility for how the function is carried out.

The Care Act is clear that anything done (or not done) by the third party in carrying out the function is to be treated as if it has been done (or not done) by the local authority itself. This is a core principle of allowing delegation of care and support functions.

The power to delegate functions does not supersede the ability for NHS and local authorities to enter into partnership arrangements under the National Health Service Act 2006. This means that local authorities can enter into partnership arrangements with the NHS for the NHS to carry out the local authority’s ‘health related functions’. This effectively authorises NHS bodies to exercise those prescribed functions, including the safeguarding functions that local authorities are prohibited from delegating under the Care Act (see below).

All care and support functions under the Care Act can be included in such partnership arrangements except charging, carrying out financial assessments and debt recovery.

The local authority would still remain legally responsible for how its functions are carried out via partnership arrangements, as with delegated functions.

3. Redress

People using care and support will always have a means of redress (or complaint) against the local authority for how any of its functions are carried out. For example, a local authority might delegate needs assessments to another organisation, which has its own procedures for handling complaints. If the adult, to whom the assessment relates, has a complaint about the way in which it was carried out they may choose to take it up with the organisation in question. If this does not satisfy the adult, however, or if they simply choose to complain directly to the local authority, the local authority will remain responsible for addressing the complaint.

In delegating care and support functions, local authorities should have regard to the local authority version of the Data Security and Protection Toolkit, in particular ensuring that all formal contractual arrangements include compliance with information governance requirements.

4. Contracts

The success of delegating functions to a third party will be determined to a large extent, by the strength and quality of the contracts that the local authorities make with the third party.

The local authority should ensure that contracts are drafted by staff with the necessary skills and competencies to do so.

Through the terms of their contracts local authorities have the power to impose conditions on how delegated functions are carried out. For example, when delegating assessments the local authority could choose to require that assessments must be carried out by people with a particular training or expertise, and that the training must be kept up to date.

The delegated organisation will be liable to the local authority for any breach of the contract, therefore the contract is the mechanism through which the local authority can ensure that delegated functions are carried out properly, and through which they may hold the contractor to account.

If the local authority delegates care and support functions to a third party, it should specify how long the authorisation lasts and make clear that it may revoke the authorisation at any time during that period.

Monitoring arrangements should be put in place by the local authority so that they can make sure that delegated functions are being out in an appropriate manner. This should involve building good working relationships with third parties to enable the local authority to guide third parties in carrying out delegated functions, and to learn about innovations and knowledge that third parties may be able to provide.

Since care and support functions are public functions, they must be carried out in a way that is compatible with all of the local authority’s legal obligations. For example, the local authority would be liable for any breach of its legal obligations under the Human Rights Act 1998 or the Data Protection Act 2018 by the third party. Therefore the local authority must ensure that they draw up contracts so as to ensure that third parties carry out functions in a way that is compatible with all of the local authorities legal obligations.

Local authorities retain overall responsibility for how functions are carried out, but delegated organisations will be responsible for any criminal proceedings brought against them.

The local authority can choose the extent to which they delegate their functions. For example, they could authorise an external party to carry out all the elements of the function, including for example taking final decisions, or it can limit the steps the authorised organisation may take, leaving any final decisions to the local authority. Local authorities should make clear in its contracts with authorised parties, the extent to which the function is being delegated.

The fact that the local authority delegates its functions does not mean that it cannot also continue to exercise that function itself. So, for instance the local authority could ask a specialist mental health organisation to carry out care and support planning for people with specific mental health conditions, but it may choose to do care and support planning for people with other mental health conditions itself. Or it may choose to offer people a choice between itself and the external organisation.

5. Functions which may not be delegated

The Care Act does not allow certain functions to be delegated.

These are:

  • integration and cooperation: Local authorities must cooperate and integrate with local partners. Delegating these functions would not allow them to meet their duty to work together with other agencies. Local authorities, however, should take steps to ensure that authorised parties cooperate with other partners, work in a way which supports integration, and is consistent with their own responsibilities.
  • safeguarding: The Care Act puts in place a legal framework for adult safeguarding, including:
    • the establishment of Safeguarding Adults Boards (SABs);
    • carrying out safeguarding adult reviews;
    • making safeguarding enquiries.

Since the local authority must be one of the members of SABs and it must take the lead role in adult safeguarding, it may not delegate these statutory functions to another party.

However, it may commission or arrange for other parties to carry out certain related activities. For those functions which may not be delegated (as outlined above) and as well as other functions which may be delegated, local authorities may wish to use outside expertise to carry out practical activities to support it in discharging those functions, rather than fully or formally delegating the function itself to be carried out by another party. For example, as set out above local authorities may not delegate their functions relating to establishing Safeguarding Adult Boards, making safeguarding enquiries or arranging safeguarding reviews. The duty, however, is for local authorities to make enquiries or cause them to be made.

The local authority could make an arrangement for a third party to undertake the enquiries where necessary. But, while a local authority can ask others to carry out an actual enquiry, it cannot delegate its responsibility for ensuring that this happens and ensuring that, where necessary, any appropriate action is taken.

There can be some uncertainty about the difference between:

  • delegation of a statutory care and support function; and
  • commissioning, arranging or outsourcing activities relating to the function.

Local authorities should seek legal advice about whether the activity it is seeking to commission another party to undertake is a legal function under Part 1 of the Care Act or not.

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CARE ACT 2014

Under the Care Act, local authorities have a duty to arrange an independent advocate to help support the participation of adults or carers who are involved in safeguarding enquiries or safeguarding adults reviews

RELEVANT CHAPTERS

Mental Capacity

Independent Mental Capacity Advocates and Independent Mental Health Advocates 

RELEVANT INFORMATION

Chapter 7, Independent Advocacy, Care and Support Statutory Guidance (Department of Health and Social Care)

Advocacy Services for Adults with Health and Social Care Needs (NICE)

LOCAL INFORMATION

Your Voice Counts Advocacy Services

1. Introduction

When an adult with care and support needs is referred to the local authority because of a safeguarding concern, they must be actively involved in any safeguarding enquiry or safeguarding adult review (SAR). Under the Care Act, the local authority has a legal duty to provide independent advocacy to support adults through these processes, if they would otherwise have substantial difficulty in being involved (see Section 3.1 Substantial difficulty).

Advocacy should be seamless for adults who qualify, so that they can benefit from the support of one advocate throughout the safeguarding process. Adults who have substantial difficulty in engaging should not be expected to have to tell their story repeatedly to different advocates.

The aim of independent advocacy support is for the adult’s wishes, feelings and needs to be at the heart of the any safeguarding enquiry or SAR.

2. Local Authority Responsibilities to Provide Independent Advocacy

The local authority has a duty to arrange an independent advocate for:

  • all adults, as part of their own assessment and care planning and care reviews and to those in their role as carers;
  • adults who are subject to a safeguarding enquiry or SAR.

There are two conditions which also need to be met for the provision of an independent advocate. These are that:

  1. if an independent advocate were not provided the adult would have substantial difficulty in being fully involved in these processes;
  2. there is no appropriate person available to support and represent the adult’s wishes who is not paid or professionally engaged in providing care or treatment to them or their carer.

The role of the independent advocate is to support and represent the adult, and to facilitate their involvement in the key processes and interactions with the local authority and other organisations as required for the safeguarding enquiry or SAR.

Local authorities also provide advocates for children who are approaching the transition to adult care and support, or who are having a young carer’s assessment.

3. Advocacy and the Duty to Involve

Adults must be fully involved in decisions made about them and in any safeguarding enquiry or SAR.

The local authority must help adults to understand how they can be involved, how they can contribute and take part and, where appropriate, lead or direct the process. Adults should be active partners in any enquiries in relation to abuse or neglect. No matter how complex the adult’s needs, local authorities are required to involve them, to help them express their wishes and feelings, to support them to weigh up options, and to make their own decisions.

The advocacy duty applies to safeguarding enquiries or SARs for adults living in all settings, except prisons.

Adults who qualify for advocacy under the Care Act may also qualify for advocacy under the Mental Capacity Act (MCA) 2005. The same advocate can provide support as an advocate under the Care Act and under the MCA. Whichever legislation the advocate is acting under, they should meet the appropriate requirements for an advocate under that legislation.

3.1 Substantial difficulty

Local authorities must form a judgement about whether an adult has substantial difficulty in being involved with these processes. If it is thought that they do, and that there is no appropriate person to support and represent them the local authority must arrange for an independent advocate to support and represent the adult.

Many adults who qualify for advocacy under the Care Act will also qualify for advocacy under the Mental Capacity Act 2005 (MCA). The same advocate can provide support as an advocate under the Care Act and under the MCA. This is to enable the adult to receive seamless advocacy so that they do not have to repeat their story. Whichever legislation the advocate is acting under, they should meet the appropriate requirements for an advocate under that legislation.

3.1.1 Judging ‘substantial difficulty’ in being involved

The Care Act defines four areas in which an adult may experience substantial difficulty:

  1. Understanding relevant information: Often adults can be supported to understand relevant information, if it is presented appropriately and if time is taken to explain it. Some however, will not be able to understand relevant information, for example if they have mid-stage or advanced dementia.
  2. Retaining information: If the adult is unable to retain information long enough to be able to weigh up options and make decisions, then they are likely to have substantial difficulty in engaging and being involved in the process.
  3. Using or weighing the information as part of engaging: The adult must be able to weigh up information, in order to participate fully and choose between options. For example, they need to be able to weigh up the advantages and disadvantages of moving into a care home or leaving an abusive relationship. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process.
  4. Communicating their views, wishes and feelings: The adult must be able to communicate their views, wishes and feelings either by talking, writing, signing or any other means, to aid the decision process and to make their priorities clear. If they are unable to do this, they will have substantial difficulty in engaging and being involved in the process. For example, an adult with mid-stage or advanced dementia, significant learning disabilities, a brain injury or mental ill health may be considered to have substantial difficulty in communicating their views, wishes and feelings. The adult’s ability to communicate their views, wishes and feelings will be key to their involvement rather than the diagnosis or specific condition.

4. Advocacy Support for Safeguarding Enquiries and Safeguarding Adults Reviews (SARs)

If the adult has substantial difficult in engaging with the safeguarding enquiry process or SAR, and there is no one else appropriate who can support them (see Section 5, Identifying an Appropriate Person), the local authority must arrange for an independent advocate to support and represent them. Where an independent advocate has already been arranged under the Care Act or under the MCA 2005 then, unless inappropriate, the same advocate should be used.

Effective safeguarding is about seeking to promote the adult’s rights as well as protecting their physical safety and taking action to prevent the occurrence or reoccurrence of abuse or neglect. It involves enabling the adult to understand any risks of abuse, and the actions that they can take, or ask others to take, to reduce those risks.

If a safeguarding enquiry needs to start urgently it can begin before an advocate is appointed, but one must be appointed as soon as possible.

Advocacy is especially important in supporting adults through difficult and / or sensitive processes (whether as part of a safeguarding enquiry or a SAR). Both can feel very daunting and involve the sharing of sensitive information which may lead to difficult decisions. Adults who have been abused or neglected may be demoralised, frightened, embarrassed or upset, and the support of an independent advocate will be crucial.

5. Identifying an Appropriate Person

Identifying an appropriate person should be considered as soon as the adult’s need for an independent advocate has been identified. An appropriate person is someone who can support the adult to be involved in the decision-making process, such as a family member or friend. For someone to act as an appropriate person, they must not speak on behalf of the adult, but have the skills to maximise their involvement.

Positives to consider when family or friends as an appropriate person include:

  • they know the adult best;
  • they would most likely want to support the adult;
  • they will likely be able to support the adult with any speaking or hearing difficulties, for example if the adult uses Makaton but has their own signs for different things.

However, family and friends:

  • may not have the necessary skills to maximise the adult’s involvement in the process;
  • may find it difficult to take a holistic approach and may only see what they believe is best for the adult;
  • may not be wanted by the adult to act as their appropriate person as it may impact the dynamics between them;
  • may find it difficult to support the adult they are in crisis and there is a conflict of interest.

When the local authority is considering whether there is an appropriate person (or persons) who can support the adult’s involvement, there are three specific considerations.

  1. they cannot be someone who is already providing the adult with care or treatment in a professional capacity or on a paid basis (regardless of who employs or pays for them).  For example, the adult’s GP, nurse, key worker or care and support worker.
  2. If the adult does not wish to be supported by that person and they have the mental capacity to make that decisions, or are competent to consent, their wishes should be respected. If the adult has been assessed as lacking the mental capacity to make such a decision, then the local authority must be satisfied that it is in their best interests to be supported and represented by the person. For example where an adult does not wish to be supported by a relative, perhaps because they wish to be moving towards independence from their family, then the relative cannot be considered an appropriate person .
  3. The appropriate person is expected to support and represent the adult and to facilitate their involvement in the processes. Some people will not be able to fulfil this role easily, for instance:
    • a family member who lives at a distance and who only has occasional contact with the adult;
    • a spouse who also finds it difficult to understand the local authority processes;
    • or a housebound parent.

It is not sufficient to know the adult well or to love them deeply; the role of the appropriate person is to support the adult’s active involvement with the local authority processes.

Anyone who is implicated in any enquiry into abuse or neglect or who has been judged by a SAR to have failed to prevent an abuse or neglect is not suitable to support the adult in any of the processes.

Sometimes the local authority will not know at the point of first contact or at an early stage in the process whether there is someone appropriate to assist the adult in engaging. An advocate may be appointed before it is identified that there is an appropriate person in the adult’s own network. The advocate can at that stage ‘hand over’ to the appropriate person. Alternatively, the local authority may agree with the adult, the appropriate person and the advocate that it would be best for the advocate to continue their role, though this is not a specific requirement under the legislation.

Equally, it is possible that the local authority will consider someone appropriate who may then turn out to have difficulties in supporting the adult to engage and be involved in the process. The local authority must at that point arrange for an advocate.

There may also be some cases where the local authority considers that the adult needs the support of both a family member and an advocate; perhaps because the family member can provide a lot of information but not enough support, or because while there is a close relationship, there may be a conflict of interest with the relative, for example in relation to inheritance of the home.

If the local authority is required to appoint an independent advocate as the adult does not have friends or family who can facilitate their involvement, friends or family members must still be consulted when the adult asks for this.

Where adults in the same household are involved in the safeguarding enquiry or SAR process, they may have the same advocate, if all parties agree and the local authority is satisfied that there is no conflict of interest.

6. The Role of the Independent Advocate

The advocate will decide the best way of supporting and representing the adult  they are advocating for, always taking into account the wellbeing and interests (including their views, beliefs and wishes) of the adult concerned.

Acting as an advocate for an adult who has substantial difficulty in engaging with safeguarding processes is a responsible position.

It includes:

  • assisting the adult to understand what is involved in a safeguarding enquiries and SARs. It can involve advocates spending considerable time with the adult, to understand their communications needs, their wishes and feelings and their life story, and using all this to assist the adult o be involved and where possible to make decisions;
  • assisting the adult to communicate their views, wishes and feelings to the staff who are carrying safeguarding enquiries or reviews;
  • assisting the adult to understand their right to have their concerns about abuse taken seriously and responded to appropriately. Also assisting the adult to understand their wider rights, including their rights to liberty and family life. An adult’s rights are complemented by the local authority’s duties, for example to involve them and to meet needs in a way that is least restrictive of their rights;
  • assisting the adult to challenge a decision or process made by the local authority; and where the adult cannot challenge the decision even with assistance, then to challenge it on their behalf.

6.1 Safeguarding issues

In terms of safeguarding there are some particularly important issues for advocates to address. These include assisting the adult to:

  • decide what outcomes / changes they want;
  • understand the behaviour of others that are abusive / neglectful;
  • understand which actions of their own may expose them to  abuse or neglect;
  • understand what actions that they can take to safeguard themselves;
  • understand what advice and help they can expect from others, including the criminal justice system;
  • understand what parts of the process are completely or partially within their control;
  • explain what help they want to avoid reoccurrence and also recover from the experience.

6.2 Making representations

There will be times when an advocate will have concerns about the way the local authority has acted or a decision that has been made or outcome that is proposed. The advocate must write a report outlining their concerns for the local authority. The local authority should hold a meeting with the advocate to consider the concerns and provide a written response to the advocate following the meeting.

Where the adult does not have the mental capacity, or is not otherwise able, to challenge a decision, the advocate must challenge any decision where they believe the decision is inconsistent with the local authority’s duty to promote the adult’s wellbeing.

Where an adult has been assisted and supported and nevertheless remains unable to make their own representations or their own decisions, the independent advocate must use what information they have, to make the representations on their behalf

They must ‘advocate’ on their behalf, to put their case, to scrutinise the options, to question the plans if they do not appear to meet all eligible needs or do not meet them in a way that fits with the adult’s wishes and feelings, or are not the least restrictive of option, and to challenge local authority decisions where necessary.

The ultimate goal of this representation is to secure the adult’s rights, promote their wellbeing and ensure that their wishes are taken fully into account.

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RELEVANT CHAPTER

Equality, Diversity and Human Rights in a Safeguarding Context

Dignity, Compassion and Respect

Promoting Wellbeing

RELEVANT INFORMATION

Resources to support Making Safeguarding Personal (LGA)  – tools to support safeguarding practice

Making Safeguarding Personal Toolkit (LGA)

Making Safeguarding Personal Toolkit – Case Studies (LGA)

Revisiting Safeguarding Practice (DHSC) 

1. Introduction

Making Safeguarding Personal (MSP) is a person-centred and outcome focused approach to safeguarding adults. It emphasises that the adult concerned must always be at the centre of adult safeguarding, and that their wishes and views should be sought at the earliest opportunity. MSP requires professionals to see adults as experts in their own lives and to work with them in order to identify strengths-based and outcomes focused solutions. Professionals must work in a way that enhances individual involvement, choice and control as part of improving quality of life, wellbeing and safety.

MSP seeks to achieve:

  • a personalised approach that enables safeguarding to be done with, not to, people;
  • practice that focuses on achieving meaningful improvement to people’s circumstances (outcomes) rather than just the process of ‘investigation’ and reaching a ‘conclusion’;
  • an approach that utilises social work skills rather than just ‘putting people through a process’, with the ultimate aim of improving outcomes for people at risk of harm.

MSP is led by the Local Government Association (LGA) Safeguarding Adults Programme and by Association of Directors of Adult Social Services (ADASS).

The Care and Support Statutory Guidance also states:

‘…it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised …. Making safeguarding personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Nevertheless, there are key issues that local authorities and their partners should consider. (para 14.14-14.15)

2. Key Areas for Effective Practice

MSP can be divided into a number of key areas:

  • person led and person centred:  being safe and well means different things to different people, this means the safeguarding process should be person-led and recognise people as the experts in their own lives. It should engage the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. Professionals should be interested, and look for the full picture of a person’s experience.
  • focused on outcomes, not process: safeguarding is not about undertaking a process but is a commitment to improve outcomes by working alongside people experiencing abuse or neglect. The key focus is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them (and their representatives or advocates if they lack capacity) how best those outcomes might be realised and then seeing, at the end, the extent to which desired outcomes have been realised. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding investigation, support planning and response.

3. Safeguarding Outcomes

A high quality service keeps people safe from harm. The Adult Social Care Outcomes Framework (ASCOF) reflects this priority, and emphasises the need for services to safeguard adults whose circumstances make them vulnerable and protect them from avoidable harm. Findings from this work have highlighted the clear benefits of asking adults about their experiences of support services.

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RELEVANT CHAPTERS

Types and Indicators of Abuse and Neglect

1. Introduction

Prevention is a key principle of adult safeguarding:

‘It is better to take action before harm occurs. “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help” Care and Support Statutory Guidance: 14.13)

Agencies must emphasise to all their staff the need for preventing abuse and neglect, wherever possible.

Observant professionals and other staff making early, positive interventions with individuals and families can make a huge difference to the lives of adults who are experiencing or at risk of abuse or neglect, which may prevent the deterioration of a situation or breakdown of a support network.

Agencies should implement robust risk management processes in order to prevent concerns escalating to a crisis point and requiring intervention under safeguarding adult procedures.

2. What does Prevention mean?

Effective prevention in safeguarding should be defined broadly and should include all adults with care and support needs and services. However, it should not mean adopting an overly-protective or risk-averse approach.

Prevention needs to take place in the context of person-centred support, with individuals empowered to make choices and supported to manage risks.

Everyone has a role to play in preventing abuse and neglect; including the adult themselves and their carers, staff, professionals and volunteers, and the local community / general public.

3. Prevention Interventions

Key to the successful prevention of abuse is an open culture with a genuinely person-centred approach to care underpinned by a zero tolerance policy towards abuse and neglect.

Some of the most common prevention interventions include:

  • supporting adults to safeguard themselves;
  • training and education for staff and volunteers;
  • awareness-raising;
  • providing information and advice;
  • advocacy;
  • policies and procedures;
  • community links;
  • legislation and regulation.

3.1 Supporting adults to safeguard themselves

One of the most effective ways to safeguard adults who may be vulnerable to abuse or neglect is to enable them to safeguard themselves. Empowerment and choice need to be at the core of adult safeguarding and practice, working with and supporting adults to recognise and protect themselves from abuse. It also means taking a risk-enabling approach within services and ensuring that people who use services have genuine choice.

If people are to protect themselves from abuse, staff need to support them to:

  • be aware of what abuse is;
  • be aware of who might potentially exploit or harm them;
  • be informed about their rights and have the skills and resources to be able to deal with it;
  • have the information, knowledge and confidence to take action;
  • be supported to be aware of how they can reduce the risks of being harmed or exploited (for example, avoiding potentially risky situations).

3.2 Training and education

See also Safeguarding Training for Staff and Volunteers

Some of the most common prevention interventions are training and education for staff and volunteers.

South Tyneside Safeguarding Adults Board should ensure that relevant partners provide training for staff and volunteers on the policy, procedures and professional practices that are in place locally, which reflects their roles and responsibilities in safeguarding adult arrangements.

Training should take place at all levels in an organisation and be updated regularly to reflect best practice. To ensure that practice is consistent, no staff group should be excluded.

3.3. Awareness raising

The public has a vital role in safeguarding adults through the prevention and recognition of abuse.  It is the responsibility of all agencies and organisations to ensure that there is a good level of public awareness of adult abuse and how concerns should be reported.

Public awareness campaigns can make a significant contribution to the prevention of abuse. They are more effective if backed up by information and advice about where to get help and training for staff and services to respond.

3.4. Information and advice

See also Information and Advice

Accessible information and advice are essential building blocks for prevention of abuse and for backing up public awareness campaigns. Information should be made available in a range of media and produced in different, user friendly formats for people with care and support needs and their carers.

Under the Care Act 2014, the local authority must provide information and advice to:

  • the public about how to raise concerns about the safety or wellbeing of an adult who has care and support needs;
  • support public knowledge and awareness of different types of abuse and neglect;
  • cover how to keep oneself physically, sexually, financially and emotionally safe;
  • support people to keep safe;
  • cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised;
  • provide information about the Safeguarding Adults Board.

3.5 Advocacy

See also Independent Advocacy

Advocacy can make a significant contribution to prevention of abuse through enabling adults at risk to become more aware of their rights and able to express their concerns.

Advocacy services may be preventative as they can enable adults at risk to express themselves in potential or actual abusive situations. Equally, their presence in enabling people to express themselves in other situations (for example when their needs are being assessed or at times of transition from children’s to adult services) may contribute to building confidence more generally and hence be preventative.

3.6 Policies, procedures and processes

Having robust, effective adult safeguarding procedures in place which are well-advertised and accessible and which all staff are trained in, is key to preventing abuse and neglect. There are, however, particular policies and procedures that can support the prevention of adult abuse. These include:

Effective planning in the context of person-centred care is a core element of good quality care and support, in conjunction with conducting a risk assessment. Effective care and support planning should consider any potential risks of abuse. Staff should understand the role of the care and support plan as being one facet in a strategy aimed at preventing abuse or neglect.

3.7 Community links

Both services and individuals benefit from having contact with a range of people in the community. Adults may be more vulnerable to abuse or neglect if they are isolated and cut off from families and friends. Reducing isolation through links with the community can mean there are more people who can be aware of the possibility of abuse, as well as providing links to potential sources of support for adults and their carers.

It is particularly important that carers are informed about existing services and sources of support in order to support their caring role and reduce stress, thus reducing the risk of abuse. See also Carers chapter.

3.8 Regulation and legislation

Regulation and legislation both can play a role in the prevention of abuse.

The Care Act 2014 introduced new duties and requirements of local authorities in a number of areas, including safeguarding adults.  It provides, for the first time, a legislative framework for those working in adult safeguarding.

Regulators have a key role to play in safeguarding – they can raise concerns about abusive practice and identify gaps in how standards are applied or interpreted, particularly in relation to workforce training, qualifications and skills and the effect of standards on safeguarding practice. See Care Quality Commission.

4. South Tyneside Safeguarding Adults Board and Safeguarding Children Partnership

See also Integration, Cooperation and Partnerships

Strategies for the prevention of abuse and neglect are a core responsibility of the South Tyneside Safeguarding Adults Board (SAB) and Safeguarding Children Partnership.

To prevent the abuse and neglect of adults, the SAB could involve commissioners and the Care Quality Commission to address poor quality care and to respond to intelligence that indicates the care and support services provided may be deteriorating. SABs can also involve local communities, by addressing hate crime or anti-social behaviour in a particular neighbourhood, and raising awareness of abuse and neglect so that members of the public can recognise abuse and know how to share their concerns.

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RELEVANT SECTIONS AND CHAPTERS

Safeguarding Enquiries Process

Types and Indicators of Abuse and Neglect

South Tyneside Safeguarding Adults Thresholds Guidance Tool

Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance

1. Introduction

Workers in all organisations need to be vigilant about adult safeguarding concerns. This includes people working in health and social care, policing, banking, fire and rescue services, trading standards, leisure services, faith groups, and housing.

GPs and other primary care staff may be particularly well placed to spot abuse or neglect, as in many cases they may be the only professionals with whom the adult has contact.

People in the community, such as neighbours, also have a role to play in identifying when an adult is experiencing or at risk of abuse or neglect, for example, someone who notices the elderly lady next door who lives alone has not collected the milk from her doorstep for two days.

Findings from safeguarding adult reviews have sometimes stated that if professionals or other staff had acted upon their concerns or sought more information, death or serious harm might have been prevented.

2. Raising Concerns

Anyone can witness or become aware of information suggesting that abuse or neglect is occurring. It is vital that professionals, other staff and members of the public are vigilant on behalf of those unable to protect themselves.

The adult may say or do things that raise concerns. This may come in the form of a complaint, a call for a police response, an expression of concern, or information which is revealed during a needs assessment.

Regardless of how the safeguarding concern is identified, everyone should know what to do, and where to go to get help and advice. This will include:

  • knowing about different types of abuse and neglect and their signs;
  • supporting adults to keep safe;
  • knowing who to tell about suspected abuse or neglect; and
  • supporting adults to think and weigh up the risks and benefits of different options when exercising choice and control.

Awareness campaigns for the general public and multi-agency training for all staff will contribute to achieving these objectives.

2.1 Professionals Reporting Concerns

Each organisation should have internal reporting processes that should be followed as part of the safeguarding process.

In most cases, frontline staff should report any concerns to their immediate line manager. There should be protocols in place for staff to follow when their line manager is not available (for example on leave, sick leave).

If the concerns involve another member of staff or a service user, staff should inform their line manager (see the Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance).

If it is believed that the manager may be implicated in the abuse, or the worker does not feel able to discuss it with them, they should inform a Senior Manager or someone else designated in their agency’s reporting protocol. Staff can also refer to their agency guidance on whistleblowing (see also Whistleblowing chapter).

Where there is any suspicion of abuse or neglect which relates to an adult who may be at risk living in a private, voluntary or local authority care (nursing or residential) home or adult placement, or is supported by a domiciliary or nursing care agency, the Care Quality Commission must also be informed.

3. Reporting and Responding to Abuse and Neglect

It is important that there is a professional understanding of:

  • the circumstances of abuse;
  • the wider context such as whether others may be at risk of abuse;
  • whether there is any emerging pattern of abuse;
  • whether others have witnessed abuse and the role of family members and paid staff or professionals.

A local authority may decide to undertake a safeguarding enquiry for an adult where there is no enquiry duty (under Section 42 Care Act), if it believes it is proportionate to do so and will enable it to promote the person’s wellbeing and support a preventative agenda.

The response will depend on the circumstances surrounding any actual or suspected case of abuse or neglect. For example, it is important to recognise that abuse or neglect may be unintentional and may arise because a carer is struggling to care for another person. This makes the need to take action no less important, but in such circumstances, an appropriate response could be a support package for the carer and monitoring (see also Carers chapter).

However, the primary focus must always be how to safeguard the adult. In other circumstances where the safeguarding concerns arise from abuse or neglect deliberately intended to cause harm, it would be necessary to immediately take steps to protect the adult and consider also whether to refer the matter to the police to consider whether a criminal investigation would be required or appropriate.

Defining abuse can be complex but it can involve an intentional, reckless, deliberate or dishonest act by the perpetrator. It may be physical, verbal or psychological, an act of neglect or an omission to act. In any case where anyone encounters abuse and they are uncertain about their next steps, they should contact the police or adult social care for advice.

The nature and timing of the intervention and who is best placed to lead will be, in part, determined by the circumstances. For example, where there is poor, neglectful care or practice, resulting in pressure sores, an employer led disciplinary response may be appropriate, but this situation will also need steps to improve the care given immediately and a clinical audit of practice. Commissioning or regulatory enforcement action may also be appropriate.

Early sharing of information is the key to providing an effective response where there are emerging concerns (see South Tyneside Multi Agency Information Sharing Agreement and Case Recording chapter). To ensure effective safeguarding arrangements:

  • all organisations must have arrangements in place which set out clearly the processes and the principles for sharing information between each other, with other professionals and the South Tyneside Safeguarding Adults Board; this could be via an information-sharing agreement to formalise the arrangements; and,
  • no professional should assume that someone else will pass on information which they think may be critical to the safety and wellbeing of the adult. If a professional has concerns about the adult’s welfare and believes they are suffering or likely to suffer abuse or neglect, they should share the information with the local authority, and the police if they believe or suspect that a crime has been committed.
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RELEVANT CHAPTER

Safeguarding: What is it and Why does it Matter?

Making Safeguarding Personal

SOUTH TYNESIDE SPECIFIC INFORMATION

Safeguarding Posters

Safeguarding Leaflets

1. Introduction

The Care Act 2014 identifies types of abuse, but also emphasises that organisation should not limit their view of what constitutes abuse or neglect.

The specific circumstances of an individual case should always be considered (see What is Safeguarding and Why does it Matter?). All three factors need to be satisfied for a safeguarding enquiry to be addressed in accordance with Section 42 of the Care Act 2014. The table in Section 2 describes the different types of abuse.

2. Types of Abuse

Type of Abuse Description or Supporting Guidance
Disability Hate Crime The criminal justice system defines a disability hate crime as any criminal offence, which is perceived, by the victim or any other person, to be motivated by hostility or prejudice based on a person’s disability or perceived disability. The police monitor five strands of hate crime: disability; race; religion; sexual orientation; transgender.
Discriminatory abuse Discrimination on the grounds of race, faith or religion, age, disability, gender, sexual orientation and political views, along with racist, sexist, homophobic or ageist comments or jokes, or comments and jokes based on a person’s disability or any other form of harassment, slur or similar treatment. Excluding a person from activities on the basis they are ‘not liked’ is also discriminatory abuse
Domestic abuse The Domestic Abuse Act (2021) defines domestic abuse as: Abusive behaviour that is: physical or sexual abuse; violent or threatening behaviour; controlling or coercive behaviour; economic abuse; psychological, emotional or other abuse. Applies to people aged 16+, who are personally connected to each other.
Female genital mutilation (FGM)   Involves procedures that intentionally alter or injure female genital organs for non-medical reasons. The procedure has no health benefits for girls and women. The Female Genital Mutilation Act (2003) makes it illegal to practise FGM in the UK or to take girls who are British nationals or permanent residents of the UK abroad for FGM whether or not it is lawful in another country. See also Female Genital Mutilation.
Financial or material abuse Theft, fraud, internet scamming, coercion in relation to an adult’s financial affairs or arrangements, including in connection with wills, property, inheritance or financial transactions, or the misuse or misappropriation of property, possessions or benefits. See also Financial or Material Abuse.
Forced marriage Is a term used to describe a marriage in which one or both of the parties are married without their consent or against their will. A forced marriage differs from an arranged marriage, in which both parties consent to the assistance of a third party in identifying a spouse. In a situation where there is concern that an adult is being forced into a marriage they do not or cannot consent to, there will be an overlap between action taken under the forced marriage provisions and the adult safeguarding process.

See also Forced Marriage.
Hate crime The police define Hate Crime as ‘any incident that is perceived by the victim, or any other person, to be racist, homophobic, transphobic or due to a person’s religion, belief, gender identity or disability’. It should be noted that this definition is based on the perception of the victim or anyone else and is not reliant on evidence. In addition it includes incidents that do not constitute a criminal offence.
Honour based abuse So called honour based abuse is a term used to describe abuse committed within the context of the extended family which are usually motivated by a perceived need to restore standing within the community, which is presumed to have been lost through the behaviour of the victim. Women are predominantly (but not exclusively) the victims and the violence and abuse is often committed with a degree of collusion from family members and / or the community. Some of these victims will contact the police or other organisations. However, many others are so isolated and controlled that they are unable to seek help. See Honour Based Abuse
Human trafficking Is actively being used by organised crime groups to make considerable amounts of money. This problem has a global reach covering a wide number of countries. It is run like a business with the supply of people and services to a customer, all for the purpose of making a profit. Traffickers exploit the social, cultural or financial vulnerability of the victim and place huge financial and ethical obligations on them. They control almost every aspect of the victim’s life, with little regard for the victim’s welfare and health. The organised crime groups will continue to be involved in the trafficking of people, whilst there is still a supply of victims, a demand for the services they provide and a lack of information and intelligence on the groups and their activities.
Mate Crime   A ‘mate crime’ as defined by the Safety Net Project is ‘when vulnerable people are befriended by members of the community who go on to exploit and take advantage of them. It may not be an illegal act but still has a negative effect on the individual.’ Mate crime is often difficult for police to investigate, due to its sometimes ambiguous nature, but should be reported to the police who will make a decision about whether or not a criminal offence has been committed. Mate Crime is carried out by someone the adult knows and often happens in private. In recent years there have been a number of Safeguarding Adult Reviews relating to people with a learning disability who were murdered or seriously harmed by people who purported to be their friend. See also Safe Places (mate crime resources)
Modern slavery Slavery, servitude and forced or compulsory labour. A person commits an offence if:

  • the person holds another person in slavery or servitude and the circumstances are such that the person knows or ought to know that the other person is held in slavery or servitude; or
  • the person requires another person to perform forced or compulsory labour and the circumstances are such that the person knows or ought to know that the other person is being required to perform forced or compulsory labour.

See also Modern Slavery chapter.
Neglect and acts of omission Ignoring medical, emotional or physical care needs, failure to provide access to appropriate health, social care or educational services, and the withholding of the necessities of life such as medication, adequate nutrition and heating. Neglect also includes a failure to intervene in situations that are dangerous to the person concerned or to others, particularly when the person lacks the mental capacity to assess risk for themselves.  See also Pressure Ulcers.
Organisational abuse The mistreatment, abuse or neglect of an adult by a regime or individuals in a setting or service where the adult lives or that they use. Such abuse violates the person’s dignity and represents a lack of respect for their human rights (see also Provider Concerns Process and Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance).
Physical abuse Assault, hitting, slapping, pushing, misuse of medication, restraint or inappropriate physical sanctions.
Psychological/emotional abuse Emotional abuse, threats of harm or abandonment, deprivation of contact, humiliation, blaming, controlling, intimidation, coercion, harassment, verbal abuse, cyber bullying, isolation or unreasonable and unjustified withdrawal of services or supportive networks.
Restraint Unlawful or inappropriate use of restraint or physical interventions. In extreme circumstances unlawful or inappropriate use of restraint may constitute a criminal offence. Someone is using restraint if they use force, or threaten to use force, to make someone do something they are resisting, or where an adult’s freedom of movement is restricted, whether they are resisting or not (see also Provider Concerns Process).

Restraint covers a wide range of actions. It includes the use of active or passive means to ensure that the person concerned does something, or does not do something they want to do, for example, the use of key pads to prevent people from going where they want from a closed environment.
Sexual abuse Rape, indecent exposure, sexual harassment, inappropriate looking or touching, sexual teasing or innuendo, sexual photography, subjection to pornography or witnessing sexual acts, indecent exposure and sexual assault or sexual acts to which the adult has not consented or was pressured into consenting.
Sexual exploitation Involves exploitative situations, contexts and relationships where adults (or a third person or persons) receive ‘something’ (e.g. food, accommodation, drugs, alcohol, cigarettes, affection, gifts, money) as a result of them performing, and/or another or others performing on them, sexual activities. It affects men as well as women. People who are sexually exploited do not always perceive that they are being exploited.

See also Working with Adults Affected by Child Sexual Exploitation or Organised Sexual Abuse.

NB: Pressure Ulcers

Pressure ulcers may occur as a result of neglect. Where concerns are raised regarding skin damage as a result of pressure, there is a need to raise it as a safeguarding concern within the organisation. In a minority of cases it may warrant a safeguarding concern with the local authority. Please see Pressure Ulcers: Safeguarding Adults Protocol

3. Patterns of Abuse

Incidents of abuse may be one off or multiple, and affect one person or more.

Professionals and others should look beyond single incidents or individuals, to identify patterns of harm, just as the Care Quality Commission, as the regulator of service quality, does when it looks at the quality of care in health and care services. Repeated instances of poor care may be an indication of more serious problems and of what is now described as organisational abuse. In order to see these patterns it is important that information is recorded and appropriately shared (see also South Tyneside Multi Agency Information Sharing Agreement and Case Recording chapter).

Patterns of abuse vary and include:

  • serial abuse in which the perpetrator seeks out and ‘grooms’ individuals. Sexual abuse sometimes falls into this pattern as do some forms of financial abuse;
  • long term abuse in the context of an ongoing family relationship such as domestic abuse between spouses or generations or persistent psychological abuse; or
  • opportunistic abuse such as theft occurring because money or jewellery has been left lying around.
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KEY POINTS

  • Under the Care Act, the local authority is responsible for setting up and maintaining – including review – information and advice services relating to care and support.
  • All adults – including carers – in the local authority area, who need information and advice about care and support, must be able to access the service.
  • The local authority must ensure that the information provided is of good quality, easily accessible and relevant.
  • The local authority should take opportunities to provide or signpost people to advice and information when people in need of care and support are in contact.

RELEVANT CHAPTERS

Promoting Wellbeing

Preventing, Reducing or Delaying Needs

RELEVANT INFORMATION

Chapter 3, Information and Advice, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Introduction

Having access to good quality information and advice enables people, carers and families to take control of, and make well informed choices about, their care and support and how they will fund it. Not only does information and advice help to promote people’s wellbeing by increasing their ability to exercise choice and control, it is also a vital part of preventing or delaying people’s’ need for care and support.

The local authority has a legal duty to ‘establish and maintain a service for providing people in its area with information and advice relating to care and support for adults and support for carers’ (Care and Support Statutory Guidance: 3.2).

The local authority must ensure that information and advice services cover more than just basic information about care and support and cover a range of care and support related areas. The service should also address prevention of care and support needs, finances, health, housing, employment, what to do in cases of abuse or neglect of an adult and other areas where required.

Local authorities must also provide independent advocacy to assist the person’s involvement in the care and support assessment, planning and review processes where they would otherwise have substantial difficulty in understanding, retaining or using information given to them, or in communicating their views, wishes or feelings and there is nobody else who can offer this support (see Independent Advocacy chapter).

2. Complaints

See also the chapter on Complaints or Appeals in Relation to the Safeguarding Adults Process.

Information on how to complain should be available in a range of media and produced in different, user friendly formats for people with care and support needs, and their carers. They should also be advised they can nominate an advocate or representative to speak out and act on their behalf during the complaints process if they wish (see also Independent Advocacy chapter).

3. Adult Safeguarding

The local authority and its partners have a duty to help people with care and support needs, and who may be at risk of abuse or neglect as a result of those needs, keep safe. Everyone in the community should understand the importance of safeguarding and help keep people safe.

3.1 Raising concerns and keeping safe

The local authority must provide information and advice to the public about how to raise concerns about the safety or wellbeing of an adult who has care and support needs. It should also support public knowledge and awareness of different types of abuse and neglect and how to support people to keep safe. The information and advice provided must also cover who to tell when there are concerns about abuse or neglect and what will happen when such concerns are raised, including information on the roles and responsibilities of the Safeguarding Adults Partnership.

3.2 Commissioning and partner agencies

All commissioners or providers of services in the public, voluntary or private sectors should disseminate information about these multi-agency procedures. Staff should also be familiar with their own agency’s procedures in relation to how to respond if they suspect or encounter adults who are experiencing, or at risk of, abuse or neglect. This should be incorporated in staff manuals or handbooks, detailing terms and conditions of appointment and other employment procedures so that all individual staff members are aware of their responsibilities in relation to safeguarding adults. This information should emphasise that all those who express concern will be treated seriously and will receive a positive response from their managers.

4. Who are Information and Advice Services for?

The local authority is responsible for ensuring that all adults including carers who need for information and advice about care and support can access the service.

People who are likely to need information and advice include:

  • people wanting to plan for their future care and support needs;
  • people who may develop care and support needs, or whose current care and support needs may increase. Under the Care Act, local authorities are expected to take action to prevent, delay and / or reduce the care and support needs for these people (see Preventing, Reducing or Delaying Needs);
  • people who have not contacted the local authority for assessment but are likely to be in need of care and support. Local authorities are expected to take steps to identify such people and encourage them to come forward for an assessment of their needs (see also Preventing, Reducing or Delaying Needs);
  • people who become known to the local authority (through referral, including self-referral), at first contact where an assessment of their needs is being considered;
  • people who are assessed by the local authority as currently being in need of care and support. Advice and information must be offered to these people irrespective of whether they have been assessed as having eligible needs which the local authority must meet;
  • people who have eligible needs for care and support which the local authority is currently meeting (whether the local authority is paying for some, all or none of the costs of meeting those needs;
  • people whose care and support or support plans are being reviewed;
  • family members and carers of adults with care and support needs, (or those who are likely to develop care and support needs). Local authorities are expected to have regard to the importance of identifying carers and take action to reduce their needs for support;
  • people who may benefit from financial information and advice on matters concerning care and support. Local authorities must consider the importance of identifying these people, to help them understand the financial costs of their care and support and access independent financial information and advice including from regulated financial advisers and;
  • care and support staff who have contact with and provide information and advice as part of their jobs.

4.1 Carers

The local authority must recognise and respond to specific requirements that carers have for both general and personal information and advice. A carer’s need for information and advice may be distinct from information and advice for the person for whom they are caring. Their needs may be covered together, in a similar way to the local authority combining an assessment of a person needing care and support with a carer’s assessment, but may be more appropriately addressed separately. This may include:

  • breaks from caring;
  • the health and wellbeing of carers themselves;
  • caring and advice on wider family relationships;
  • carers’ financial and legal issues;
  • caring and employment;
  • caring and education; and
  • a carer’s need for advocacy.

5. Quality of Information and Advice

The local authority must ensure that there is an accessible information and advice service that meets the needs of its population. Information and advice must be open to everyone who would benefit from it.

The local authority should ensure that information supplied is clear, meaning it can be understood and acted on by those receiving it.

It should be accurate, up to date and consistent with other sources of information and advice. Staff providing information and advice within a local authority and other frontline staff should be aware of accessibility issues and be appropriately trained.

All reasonable efforts should be taken to ensure that the information and advice provide meets the adult’s requirements, is comprehensive and is given at an early stage.

The local authority must make sure that all relevant information is available to people so they can make the best informed decision in their particular circumstances. Leaving out or withholding information is not acceptable.

There will be some circumstances where impartial information and advice are particularly important and the local authority should consider when this may be best provided by an independent organisation, rather than by the local authority itself. This is particularly likely to be the case when people need advice about if, how and when to question or challenge the decisions of the local authority.

6. Content

The local authority must ensure that information and advice is available on:

  • how the local care and support system works locally – about how the system works. This includes the assessment process, safeguarding, eligibility, and review, complaints, appeals, independent advocacy, supporting individual wellbeing charging for care and support costs, national resources, planning for future care, planning for future lack of capacity;
  • how to access the care and support available locally;
  • the choice and types of care and support, and the choice of care providers available in the local area – including prevention and reablement services and wider services that support wellbeing;
  • how to access independent financial advice on matters relating to care and support;
  • how to raise concerns about the safety or wellbeing of an adult with care and support needs (and also consider how to do the same for a carer with support needs).

Depending on local circumstances, the service should also include, information and advice on:

  • housing and housing-related support options for those with care and support needs;
  • treatment and support for health conditions, including Continuing Health Care arrangements;
  • availability and quality of health services;
  • availability of services that may help people remain independent for longer such as home improvement agencies, handyperson or maintenance services;
  • availability of befriending services and other services to prevent social isolation;
  • availability of intermediate care entitlements such as aids and adaptations;
  • eligibility and applying for disability benefits and other types of benefits;
  • availability of employment support for disabled adults;
  • children’s social care services and transition to adult care and support;
  • availability of carers’ services and benefits;
  • sources of independent information, advice and advocacy;
  • the Court of Protection, Power of Attorney and becoming a Deputy;
  • the need to plan for future care costs;
  • practical help with planning to meet future or current care costs;
  • accessible ways and support to help people understand the different types of abuse and its prevention.

7. Opportunities to Provide Information and Advice

There are a number of direct opportunities that the local authority has to provide or signpost people to advice and information. These include:

  • at first point of contact with the local authority;
  • as part of a needs or carer’s assessment, including joint Continuing Healthcare assessments;
  • during a period of reablement;
  • around and following financial assessment;
  • when considering a financial commitment such as a deferred payment agreement or top‑up agreement;
  • during or following an adult safeguarding enquiry;
  • when considering take up of a personal budget and/or Direct Payment;
  • during the care and support planning process;
  • during the review of a person’s care and support plan;
  • when a person may be considering a move to another local authority area;
  • at points in transition, for example when people needing care or carers under 18 become adults and the systems for support may change.

The local authority and its partners must also use wider opportunities to provide targeted information and advice at key points in people’s contact with the care and support, health and other local services. These may be at key ‘trigger points’ during a person’s life such as:

  • contact with other local authority services;
  • bereavement;
  • hospital entry and/or discharge;
  • diagnosis of health conditions – such as dementia, stroke or an acquired impairment for example;
  • consideration or review of Continuing Healthcare arrangements;
  • take up of power of attorney;
  • applications to Court of Protection;
  • application for, or review of, disability benefits such as Attendance Allowance and Personal Independence Payments, and for Carers Allowance;
  • access to work interviews;
  • contact with local support groups, charities, or user-led organisations including carers’ groups and disabled persons’ organisations;
  • contact with or use of private care and support services, including homes care;
  • change or loss of housing;
  • contact with the criminal justice system;
  • admission to or release from prison;
  • ‘Guidance Guarantee’ in the Pensions Act 2014;
  • retirement.

8. Accessibility of Information and Advice

The local authority should ensure that products and materials (in all formats) are as accessible as possible for all potential users Websites should meet specific standards such as the Web Content Accessibility Guidelines and guidance set out in Making Your Service Accessible (UK Government).

Printed products should be produced to appropriate guidelines with important materials available in easy-read, large print and languages other than English. Telephone services or face to face services should be available to people who do not have access to the internet or who need services to be delivered in another way to meet their specific needs. Local authorities should be particularly aware of the needs of individuals with complex but relatively rare conditions, such as deafblindness, and those with hidden disabilities.

Under the Equality Act 2010, reasonable adjustments should be made to ensure that disabled people have equal access to information and advice services. Reasonable adjustments could include the provision of information in a range of accessible formats or the provision of help with communication support. When a person contacts the information and advice service, they should be asked what what is the best way for information to be given to them, and how they prefer to communicate.

Information and advice should be available in a range of formats, including:

  • face to face contact;
  • use of social and professional contacts;
  • community settings;
  • advice and advocacy services;
  • telephone;
  • mass communications, and targeted use of leaflets, posters and so on (for example in GP surgeries);
  • use of ‘free’ media such as newspaper, local radio stations, social media;
  • the local authority’s own and other appropriate internet websites, including support for the self-assessment of needs;
  • third party internet content and applications;
  • email.

Some groups in need of information and advice about care and support may have particular requirements. These include:

  • people with sensory impairments, such as visual impairment, deafblind and hearing impaired;
  • people who do not have English as a first language;
  • people who are socially isolated;
  • people whose disabilities limit their physical mobility;
  • people with learning disabilities;
  • people with mental health problems.

Some people, including those with dementia, may benefit from an independent person to help them to access information and advice. From the point of first contact with, or referral to, the local authority, the provision of independent advocacy to support involvement in assessment, planning and reviews should be considered (see Independent Advocacy chapter).

 

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CARE ACT 2014

Local authorities must actively promote wellbeing and independence, and intervene early to support adults and carers in order to prevent, delay or reduce needs wherever possible.

RELEVANT CHAPTERS

Promoting Wellbeing

Information and Advice

RELEVANT INFORMATION

Chapter 2, Preventing, Reducing or Delaying Needs, Care and Support Statutory Guidance (Department of Health and Social Care)

See also Preventing, Delaying or Reducing Needs case studies

March 2022: In Section 3, Intermediate Care and Reablement, information on the four models of intermediate care has been updated.

1. Introduction

It is critical to the vision in the Care Act 2014 that the care and support system works to actively promote wellbeing and independence, and does not just wait to respond when people reach a crisis point. To meet the challenges of the future, it will be vital that the care and support system intervenes early to support individuals, helps people retain or regain their skills and confidence, and prevents need or delays deterioration wherever possible.

There are many ways in which a local authority can achieve the aims of promoting wellbeing and independence and reducing dependency. The Care and Support Statutory Guidance sets out how local authorities should go about fulfilling their responsibilities, both individually and in partnership with other local organisations, communities, and people themselves.

The local authority’s responsibilities for prevention, reducing and delaying needs apply to all adults, including:

  • people who do not have any current needs for care and support;
  • adults with needs for care and support, whether their needs are eligible and / or met by the local authority or not;
  • carers, including those who may be about to take on a caring role or who do not currently have any needs for support, and those with needs for support which may not be being met by the local authority or other organisation.

The term ‘prevention’ or ‘preventative’ measures can cover many different types of support, services, facilities or other resources. There is no single definition for what constitutes preventative activity and this can range from wide scale, whole population measures aimed at promoting health, to more targeted, individual interventions aimed at improving skills or functioning for one person or a particular group or lessening the impact of caring on a carer’s health and wellbeing. In considering how to give effect to their responsibilities, local authorities should consider the range of options available, and how those different approaches could support the needs of their local communities.

‘Prevention’ is often broken down into three general approaches – primary, secondary and tertiary prevention – which are described in more detail below. The use of such terms is aimed to illustrate what type of services, facilities and resources could be considered, arranged and provided as part of a prevention service, as well as to whom and when such services could be provided or arranged. However, services can cut across any or all of these three general approaches and as such the examples provided under each approach are not to be seen as limited to that particular approach. Prevention should be seen as an ongoing consideration and not a single activity or intervention.

2. Prevent, Reduce, Delay

2.1 Prevent: primary prevention/ promoting wellbeing

These are aimed at individuals who have no current particular health or care and support needs. These are services, facilities or resources provided or arranged that may help an individual avoid developing needs for care and support, or help a carer avoid developing support needs by maintaining independence and good health and promoting wellbeing. They are generally universal (that is, available to all) services, which may include interventions and advice that:

  • provide universal access to good quality information;
  • support safer neighbourhoods;
  • promote healthy and active lifestyles;
  • reduce loneliness or isolation or;
  • encourage early discussions in families or groups about potential changes in the future, for example conversations about potential care arrangements or suitable accommodation should a family member become ill or disabled.

2.2 Reduce: secondary prevention/ early intervention

These are more targeted interventions aimed at individuals who have an increased risk of developing needs, where the provision of services, resources or facilities may help slow down or reduce any further deterioration or prevent other needs from developing. Some early support can help stop a person’s life tipping into crisis, for example helping someone with a learning disability with moderate needs manage their money, or a few hours support to help a family carer who is caring for their son or daughter with a learning disability and behaviour that challenges at home.

Early intervention could also include a fall prevention clinic, adaptations to housing to improve accessibility or provide greater assistance, handyman services, short term provision of wheelchairs or telecare services. In order to identify those individuals most likely to benefit from such targeted services, local authorities may undertake screening or case finding, for instance to identify individuals at risk of developing specific health conditions or experiencing certain events (such as strokes, or falls), or those that have needs for care and support which are not currently met by the local authority. Targeted interventions should also include approaches to identifying carers, including those who are taking on new caring responsibilities. Carers can also benefit from support to help them develop the knowledge and skills to care effectively and look after their own health and wellbeing.

2.3 Delay: tertiary prevention

These are interventions aimed at minimising the effect of disability or deterioration for people with established or complex health conditions, (including progressive conditions, such as dementia), supporting people to regain skills and manage or reduce need where possible. Tertiary prevention could include, for example the rehabilitation of people who are severely sight impaired. Local authorities must provide or arrange services, resources or facilities that maximise independence for those already with such needs, for example, interventions such as the provision of formal care such as meeting a person’s needs in their own home; rehabilitation / reablement services, for example community equipment services and adaptations; and the use of joint case management for people with complex needs.

Tertiary prevention services could also include helping improve the lives of carers by enabling them to continue to have a life of their own alongside caring, for example through respite care, peer support groups like dementia cafés, or emotional support or stress management classes which can provide essential opportunities to share learning and coping tips with others. This can help develop mechanisms to cope with stress associated with caring and help carers develop an awareness of their own physical and mental health needs.

Prevention is not a one off activity. For example, a change in the circumstances of an adult and/or carer may result in a change to the type of prevention activity that would be of benefit to them. Prevention can sometimes be seen as something that happens primarily at the time of (or very soon after) a diagnosis or assessment or when there has been a subsequent change in the person’s condition. Prevention services are, however, something that should always be considered. For example, at the end of life in relation to carers, prevention services could include the provision of pre-bereavement support.

3. Intermediate Care and Reablement

‘Intermediate care’ is a time limited, structured programme of care to assist a person to maintain or regain their ability to live independently at home. ‘Reablement’ is a type of intermediate care, which aims to help the person regain their capabilities and live independently in their own home.

There is a tendency for the terms ‘reablement’, ‘rehabilitation’ and ‘intermediate care’ to be used interchangeably.

There are four models of intermediate care (see Intermediate Care (SCIE):

  1. Bed-based services are provided in an acute hospital, community hospital, residential care home, nursing home, standalone intermediate care facility, independent sector facility, local authority facility or other bed-based settings.
  2. Community-based services provide assessment and interventions to people in their own home or a care home.
  3. Crisis response services are based in the community and are provided to people in their own home or a care home with the aim of avoiding hospital admissions.
  4. Reablement services are based in the community and provide assessment and interventions to people in their own home or a care home. These services aim to help people recover skills and confidence to live at home and maximise their independence.

The term ‘rehabilitation’ is sometimes used to describe a particular type of service designed to help a person regain or re-learn some capabilities where these capabilities have been lost due to illness or disease. Rehabilitation services can include provisions that help people attain independence and remain or return to their home and participate in their community, for example independent living skills and mobility training for people with visual impairment.

‘Intermediate care’ services are provided to people, usually older people, after they have left hospital or when they are at risk of being sent to hospital. Intermediate care is a programme of care provided for a limited period of time to assist a person to maintain or regain the ability to live independently – as such they provide a link between places such as hospitals and people’s homes, and between different areas of the health and care and support system – community services, hospitals, GPs and care and support.

To prevent needs emerging across health and care, integrated services should draw on a mixture of qualified health, care and support staff, working collaboratively to deliver prevention. This could involve, for instance, reaching beyond traditional health or care interventions to help people develop or regain the skills of independent living and active involvement in their local community.

4. Carers and Prevention

Carers play a significant role in preventing the needs for care and support for the people they care for, which is why it is important that local authorities consider preventing carers from developing needs for care and support themselves. There may be specific interventions for carers that prevent, reduce or delay the need for carers’ support. These interventions may differ from those for people without caring responsibilities. Examples of services, facilities or resources that could contribute to preventing, delaying or reducing the needs of carers may include but is not limited to those which help carers to:

  • care effectively and safely – both for themselves and the person they are supporting, for example timely interventions or advice on moving and handling safely or avoiding falls in the home, or training for carers to feel confident performing basic health care tasks;
  • look after their own physical and mental health and wellbeing, including developing coping mechanisms;
  • make use of IT and assistive technology;
  • make choices about their own lives, for example managing their caring role and paid employment;
  • find support and services available in their area;
  • access the advice, information and support they need including information and advice on welfare benefits, other financial information and entitlement to carers’ assessments.

As with the people they care for, the duty to prevent carers from developing needs for support is distinct from the duty to meet their eligible needs. While a person’s eligible needs may be met through universal preventative services, this will be an individual response following a needs or carers assessment. Local authorities cannot fulfil their universal prevention duty in relation to carers simply by meeting eligible needs, and nor would universal preventative services always be an appropriate way of meeting carers’ eligible needs.

5. The Focus of Prevention

5.1 Promoting wellbeing

The local authority must have regard to promote wellbeing and its principles (see Promoting Wellbeing chapter), and view an individual’s life holistically. This will mean considering care and support needs in the context of the person’s skills, ambitions, and priorities. This should include consideration of the role a person’s family or friends can play in helping the person to meet their goals. This is not creating or adding to their caring role but including them in an approach supporting the person to live as independently as possible for as long as possible. In regard to carers, the local authority should consider how they can be supported to look after their own health and wellbeing and to have a life of their own alongside their caring responsibilities.

As highlighted in the case study, where people live alone a person may not always have the support from family or friends because they may not live close by. For this group of people prevention needs to be considered through other means, such as the provision of community services and activities that would help support people to maintain an independent life.

5.2 Developing resilience and promoting individual strength

In developing and delivering preventative approaches to care and support, local authorities should ensure that individuals are not seen as passive recipients of support services, but are able to design care and support based around achievement of their goals. Local authorities should actively promote participation in providing interventions that are co-produced with individuals, families, friends, carers and the community. ‘Co-production’ is when an individual influences the support and services received, or when groups of people get together to influence the way that services are designed, commissioned and delivered. Such interventions can contribute to developing individual resilience and help promote self-reliance and independence, as well as ensuring that services reflect what the people who use them want.

Through the assessment process, an individual will have direct contact with a local authority. A good starting point for a discussion that helps develop resilience and promotes independence would be to ask: ‘what does a good life look like for you and your family and how can we work together to achieve it?’ Giving people choice and control over the support they may need and access to the right information enables people to stay as well as possible, maintain independence and caring roles for longer.

Social workers, occupational therapists, other professionals, service providers and commissioners who are effective at preventing, reducing, or delaying needs for care and support are likely to have a holistic picture of the individuals and families receiving support. This will include consideration of a person’s strengths and their informal support networks as well as their needs and the risks they face. This approach recognises the value in the resources of voluntary and community groups and the other resources of the local area.

5.3 Developing a local approach to preventative support

The local authority must provide or arrange for services, facilities or resources which would prevent, delay or reduce an individual’s needs for care and support, or the needs for support of carers. It should develop a clear, local approach to prevention which sets out how they plan to fulfil this responsibility, taking into account the different types and focus of preventative support as outlined above. Developing a local approach to preventative support is a responsibility wider than adult care and support alone, and should include the involvement, by way of example, of those responsible for public health, leisure, transport, and housing services which are relevant to the provision of care and support.

5.4 Working with other partners to focus on prevention

Whilst local authorities may choose to provide some types of preventative support themselves, others may be more effectively provided in partnership with other local partners (for example rehabilitation or falls clinics provided jointly with the local NHS), and further types may be best provided by other organisations (for example specialist housing providers or some carers’ services). A local authority’s commissioning strategy for prevention should consider the different commissioning routes available, and the benefits presented by each. This could include connecting to other key areas of local preventative activity outside care, including housing, planning and public health.

In developing a local approach to prevention, the local authority must take steps to identify and understand both the current and future demand for preventative support, and the supply in terms of services, facilities and other resources available.

Local authorities must consider the importance of identifying the services, facilities and resources that are already available in their area, which could support people to prevent, reduce or delay needs, and which could form part of the overall local approach to preventative activity. Understanding the breadth of available local resources will help the local authority to consider what gaps may remain, and what further steps it should itself take to promote the market or to put in place its own services.

Where the local authority does not provide such types of preventative support itself, it should have mechanisms in place for identifying existing and new services, maintaining contact with providers over time, and helping people to access them. Local approaches to prevention should be built on the resources of the local community, including local support networks and facilities provided by other partners and voluntary organisations.

Local authorities must promote diversity and quality in provision of care and support services, and ensure that a person has a variety of providers from which to choose. Considering the services, facilities and resources which contribute towards preventing or delaying the development of needs for care and support is a core element of fulfilling this responsibility. A local authority should engage local providers of care and support in all aspects of delivery and encourage providers to innovate and respond flexibly to develop interventions that contribute to preventing needs for care and support.

Local authorities should consider the number of people in its area with existing needs for care and support, as well as those at risk of developing needs in the future, and what can be done to prevent, delay or reduce those needs now and in the future. In doing so, a local authority should draw on existing analyses such as the Joint Strategic Needs Assessment, and work with other local partners such as the NHS and voluntary sector to develop a broader, shared understanding of current and future needs, and support integrated approaches to prevention.

In particular, local authorities must consider how to identify ‘unmet need’ – that is those people with needs which are not currently being met, whether by the local authority or anyone else. Understanding unmet need will be crucial to developing a longer-term approach to prevention that reflects the true needs of the local population. This assessment should also be shared with local partners, such as through the health and wellbeing board, to contribute to wider intelligence for local strategies. Preventative services, facilities or resources are often most effective when brought about through partnerships between different parts of the local authority and between other agencies and the community such as those people who are likely to use and benefit from these services.

Local authorities should consider how they can work with different partners to identify unmet needs for different groups and coordinate shared approaches to preventing or reducing such needs, for example working with the NHS to identify carers, and working with independent providers including housing providers and the voluntary sector, who can provide local insight into changing or emerging needs beyond eligibility for publicly funded care.

5.5 Working with other partners to focus on prevention

Developing and delivering local approaches to prevention, the local authority should consider how to align or integrate its approach with that of other local partners. Preventing needs will often be most effective when action is undertaken at a local level, with different organisations working together to understand how the actions of each may impact on the other.

Within the local authority, prevention of care and support needs is closely aligned to other local authority responsibilities in relation to public health, children’s services, and housing, for example. Across the local landscape, the role of other bodies including the local NHS (for example GPs, dentists, pharmacists, ophthalmologists etc.), welfare and benefits advisers (for example at Jobcentre Plus), the police, fire service, prisons in respect of those persons detained or released with care and support needs, service providers and others will also be important in developing a comprehensive approach.

Local authorities must ensure the integration of care and support provision, including prevention with health and health-related services, which include housing (see Integration, Cooperation and Partnerships chapter). This responsibility includes in particular a focus on integrating with partners to prevent, reduce or delay needs for care and support.

A local authority must cooperate with each of its relevant partners and the partners must cooperate with the local authority, for example, in relation to the provision of preventative services and the identification of carers, a local authority must cooperate with NHS bodies.

A local authority must also set up arrangements between its relevant partners and individual departments in relation to its care and support functions, which includes prevention. Relevant partners and individual departments include, but are not limited to, housing departments where, for example, housing services or officers may be well placed to identify people with dementia and their carers, and provide housing related support and/or in partnership with others, home from hospital services or ‘step up step down’ provision.

5.6 Identifying those who may benefit from preventative support

The local authority should put in place arrangements to identify and target those individuals who may benefit from particular types of preventative support. Helping people to access such types of support when they need it is likely to have a significant impact on their longer term health and wellbeing, as well as potentially reducing or delaying the need for ongoing care and support from the local authority.

In developing such approaches, the local authority should consider the different opportunities for coming into contact with people who may benefit, including where the first contact maybe with a professional outside the local authority for example, GPs, pharmacists or welfare and benefit advisers. There are a number of interactions and access points that could bring a person into contact with the local authority or a partner organisation and act as a trigger point for the local authority to consider whether the provision of a preventative service or some other step is appropriate. These may include:

  • initial contact through a customer services centre, whether by the person concerned or someone acting on their behalf;
  • contact with a GP, community nurses, housing officers or other professionals which leads to a referral to the local authority;
  • an assessment of needs or a carer’s assessment, which identifies the person may benefit from a preventative service or other type of local support.

Many people with low level care and support needs will approach the voluntary sector for advice in the first instance. Local authorities and the voluntary sector should work together on how it can share this information to gain a fuller picture of local need as possible. Authorities should bring data from these different sources together to stratify who in the community may need care and support in the future and what types of needs they are likely to have, and use this information to target their preventative services effectively.

Prevention should be a consistent focus for the local authority in undertaking their care and support functions. However, there may be key points in a person’s life or in the care and support process however, where a preventative intervention may be particularly appropriate or of benefit to the person. The local authority should consider circumstances which may help to identify people who may benefit from preventative support, for example:

  • bereavement;
  • hospital admission and or discharge;
  • people who have been recently admitted to or released from prison;
  • application for benefits such as Attendance Allowance, or Carer’s Allowance;
  • contact with/use of local support groups;
  • contact with/use of private care and support;
  • changes in housing.

A local authority must establish and maintain a service for providing people with information and advice relating to care and support (see Information and Advice chapter). In addition to any more targeted approaches to communicating with individuals who may benefit from preventative support, this service should include information and advice about preventative services, facilities or resources, so that anyone can find out about the types of support available locally that may meet their individual needs and circumstances, and how to access them.

5.7 Helping people access preventative support

A variety of different kinds of service, facilities or resources can be preventative and can help individuals live well and maintain their independence or caring roles for longer.

Local authorities should be innovative and develop an approach to prevention that meets the needs of their local population. A preventative approach requires a broad range of interventions, as one size will not fit all.

Where a local authority has put in place mechanisms for identifying people who may benefit from a type of preventative support, it should take steps to ensure that the person concerned understands the need for the particular measure, and is provided with further information and advice as necessary.

Contact with a person who is identified as being able to benefit from preventative support may lead to the local authority becoming aware that the person appears to have needs for care and support, including support as a carer. This appearance of need is likely to trigger a needs assessment or a carer’s assessment. However, where a local authority is not required to carry out such an assessment, it should nonetheless take steps to establish whether the person identified will benefit from the type of preventative support proposed.

Where a person is provided with any type of service or supported to access a facility or resource as a preventative measure, the local authority should also provide the person with information in relation to the measure undertaken. The local authority is not required to provide a care and support plan or a carer’s support plan where it provides prevention services only. It should, however, consider which aspects of a plan should be provided in these circumstances, and should provide such information as is necessary to enable the person to understand:

  • what needs the person has or may develop, and why the intervention or other action is proposed in their regard;
  • the expected outcomes for the action proposed, and any relevant timescale in which those outcomes are expected; and
  • what is proposed to take place at the end of the measure (for instance, whether an assessment of need or a carer’s assessment will be carried out at that point).

The person concerned must agree to the provision of any service or other step proposed by the local authority. Where the person refuses but continues to appear to have needs for care and support (or for support, in the case of a carer), the local authority must offer the individual an assessment.

6. Assessment of the Needs of Adults and Carers

In assessing whether an adult has any care and support needs or a carer has any needs for support, the local authority must consider whether the person concerned would benefit from the preventative services, facilities or resources provided by the local authority or which might otherwise be available in the community. This is regardless of whether, in fact, the adult or carer is assessed as having any care and support needs or support needs. As part of the assessment process, the local authority considers the capacity of the person to manage their needs or achieve the outcomes which matter to them, and allows for access to preventative support before a decision is made on whether the person has eligible needs.

As part of this process, the local authority should also take into account the person’s own capabilities, and the potential for improving their skills, as well as the role of any support from family, friends or others that could help them to achieve what they wish for from day-to-day life. This should not assume that others are willing or able to take up caring roles. Where it appears to the local authority that a carer may have needs for support (whether currently or in the future), a carer’s assessment must always be offered.

Children should not undertake inappropriate or excessive caring roles that may have an impact on their development. A young carer becomes vulnerable when their caring role risks impacting upon their emotional or physical wellbeing and their prospects in education and life. A local authority may become aware that a child is carrying out a caring role through an assessment or informed through family members or a school. A local authority should consider how supporting the adult with needs for care and support can prevent the young carer from under taking excessive or inappropriate care and support responsibilities. Where a young carer is identified, the local authority must undertake a young carer’s assessment under the Children Act 1989.

Considering the support from family, friends or others is important in taking a holistic approach to see the person in the context of their support networks and understanding how their needs may be prevented, reduced or delayed by others within the community, rather than by more formal services.

If a person is provided with care and support or support as a carer by the local authority, the authority must provide them with information and advice about what can be done to prevent, delay, or reduce their needs as part of their care and support plan or support plan. This should also include consideration of the person’s strengths and the support from other members of the family, friends or the community.

Regardless of whether or not a person is ultimately assessed as having either any needs at all or any needs which are to be met by the local authority, the authority must in any case provide information and advice in an accessible form, about what can be done to prevent, delay, or reduce development of their needs. This is to ensure that all people are provided with targeted, personalised information and advice that can support them to take steps to prevent or reduce their needs, connect more effectively with their local community, and delay the onset of greater needs to maximise their independence and quality of life. Where a person has some needs that are eligible, and also has some other needs that are not deemed to be eligible, the local authority must provide information and advice on services facilities or resources that would contribute to preventing, reducing or delaying the needs which are not eligible, and this should be aligned and be consistent with the care and support plan for the person with care needs, or support plan for the carer.

It is important that people receive information in a timely manner about the services or interventions that can help or contribute to preventing an escalation in needs for care and support. Supporting people’s access to the right information at the right time is a key element of a local authority’s responsibilities for prevention.

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– End –

CARE ACT 2014

Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of an adult. This is sometimes referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support. It also clarifies the arrangements for the role of principal social worker within local authorities.

RELEVANT CHAPTERS

Preventing, Reducing or Delaying Needs

Information and Advice

Making Safeguarding Personal

RELEVANT INFORMATION

Chapter 1, Promoting Wellbeing, Care and Support Statutory Guidance (Department of Health and Social Care)

This chapter was added to the APPP in July 2018.

1. Introduction

The core purpose of adult care and support is to help people to achieve the outcomes that matter to them in their life. Throughout the Care and Support Statutory Guidance, the different chapters set out how a local authority should go about performing its care and support responsibilities. Underpinning all of these individual ‘care and support functions’ (that is, any process, activity or broader responsibility that the local authority performs) is the need to ensure that doing so focuses on the needs and goals of the person concerned.

Local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support.

The wellbeing principle applies in all cases where a local authority is carrying out a care and support function, or making a decision, in relation to a person. For this reason it is referred to throughout this guidance. It applies equally to adults with care and support needs and their carers.

In some specific circumstances, it also applies to children, their carers and to young carers when they are subject to transition assessments (see Transition to Adult Care and Support).

2. Definition of Wellbeing

Wellbeing is a broad concept, and it is described as relating to the following areas in particular:

  • personal dignity (including treatment of the individual with respect);
  • physical and mental health and emotional wellbeing;
  • protection from abuse and neglect;
  • control by the individual over day to day life (including over care and support provided and the way it is provided);
  • participation in work, education, training or recreation;
  • social and economic wellbeing;
  • domestic, family and personal relationships;
  • suitability of living accommodation;
  • the individual’s contribution to society.

The individual aspects of wellbeing or outcomes above are those which are set out in the Care Act, and are most relevant to people with care and support needs and carers. There is no hierarchy, and all should be considered of equal importance when considering ‘wellbeing’ in the round.

3. Promoting Wellbeing

Promoting wellbeing involves actively seeking improvements in aspects of wellbeing set out above when carrying out a care and support function in relation to an individual at any stage of the process, from the provision of information and advice to reviewing a care and support plan. Wellbeing covers an intentionally broad range of the aspects of a person’s life and will encompass a wide variety of specific considerations depending on the individual.

A local authority can promote a person’s wellbeing in many ways. How this happens will depend on the circumstances, including the person’s needs, goals and wishes, and how these impact on their wellbeing. There is no set approach – a local authority should consider each case on its own merits, consider what the person wants to achieve, and how the action which the local authority is taking may affect the wellbeing of the individual.

The Act therefore signifies a shift from existing duties on local authorities to provide particular services, to the concept of ‘meeting needs’. This is the core legal entitlement for adults to care and support, establishing one clear and consistent set of duties and power for all people who need care and support.

The concept of meeting needs recognises that everyone’s needs are different and personal to them. Local authorities must consider how to meet each person’s specific needs rather than simply considering what service they will fit into. The concept of meeting needs also recognises that modern care and support can be provided in any number of ways, with new models emerging all the time, rather than the previous legislation which focuses primarily on traditional models of residential and domiciliary care.

Whenever a local authority carries out any care and support functions relating to an individual, it must act to promote wellbeing – and it should consider all of the aspects above in looking at how to meet a person’s needs and support them to achieve their desired outcomes. However, in individual cases, it is likely that some aspects of wellbeing will be more relevant to the person than others. For example, for some people the ability to engage in work or education will be a more important outcome than for others, and in these cases ‘promoting their wellbeing’ effectively may mean taking particular consideration of this aspect. Local authorities should adopt a flexible approach that allows for a focus on which aspects of wellbeing matter most to the individual concerned.

The principle of promoting wellbeing should be embedded through the local authority care and support system, but how it promotes wellbeing in practice will depend on the particular function being performed. During the assessment process, for instance, the local authority should explicitly consider the most relevant aspects of wellbeing to the individual concerned, and assess how their needs impact on them. Taking this approach will allow for the assessment to identify how care and support, or other services or resources in the local community, could help the person to achieve their outcomes. During care and support planning, when agreeing how needs are to be met, promoting the person’s wellbeing may mean making decisions about particular types or locations of care (for instance, to be closer to family). To give another example, the concept of wellbeing is very important when responding to someone who self-neglects, where it will be crucial to work alongside the person, understanding how their past experiences influence current behaviour. The duty to promote wellbeing applies equally to those who, for a variety of reasons, may be difficult to engage.

The wellbeing principle applies equally to those who do not have eligible needs but come into contact with the care and support system in some other way (for example, via an assessment that does not lead to ongoing care and support) as it does to those who go on to receive care and support and have an ongoing relationship with the local authority.

It should also inform delivery of universal services provided to all people in the local population, as well as being considered when meeting eligible needs. Although the wellbeing principle applies specifically when the local authority performs an activity or task or makes a decision in relation to a person, the principle should also be considered by the local authority when it undertakes broader, strategic functions, such as planning, which are not in relation to one individual. Wellbeing should, therefore, be seen as the common theme around which care and support is built at both local and national levels.

In addition there are a number of other key principles and standards to which the local authority must have regard to when carrying out the same activities or functions:

  1. The importance of beginning with the assumption that the individual is best placed to judge the individual’s wellbeing. Building on the principles of the Mental Capacity Act 2005, the local authority should assume that the person themselves knows best their own outcomes, goals and wellbeing. Local authorities should not make assumptions as to what matters most to the person; there should be an assumption that the individual is best placed to understand the impact of their condition/s on their outcomes and wellbeing.
  2. The individual’s views, wishes, feelings and beliefs. Considering the person’s views and wishes is critical to a person centred system. Local authorities should not ignore or downplay the importance of a person’s own opinions in relation to their life and their care. Where particular views, feelings or beliefs (including religious beliefs) impact on the choices that a person may wish to make about their care, these should be taken into account. This is especially important where a person has expressed views in the past, but no longer has capacity to make decisions themselves.
  3. The importance of preventing or delaying the development of needs for care and support and the importance of reducing needs that already exist. At every interaction with a person, a local authority should consider whether or how the person’s needs could be reduced or other needs could be delayed from arising. Effective interventions at the right time can stop needs from escalating, and help people maintain their independence for longer (see Preventing, Reducing or Delaying Needs).
  4. The need to ensure that decisions are made having regard to all the individual’s circumstances (and are not based only on their age or appearance, any condition they have, or any aspect of their behaviour which might lead others to make unjustified assumptions about their wellbeing). Local authorities should not make judgments based on preconceptions about the person’s circumstances, but should in every case work to understand their individual needs and goals.
  5. The importance of the individual participating as fully as possible. In decisions about them and being provided with the information and support necessary to enable the individual to participate. Care and support should be personal, and local authorities should not make decisions from which the person is excluded.
  6. The importance of achieving a balance between the individual’s wellbeing and that of any friends or relatives who are involved in caring for the individual. People should be considered in the context of their families and support networks, not just as isolated individuals with needs. Local authorities should take into account the impact of an individual’s need on those who support them, and take steps to help others access information or support.
  7. The need to protect people from abuse and neglect. In any activity which a local authority undertakes, it should consider how to ensure that the person is and remains protected from abuse or neglect. This is not confined only to safeguarding issues, but should be a general principle applied in every case including with those who self-neglect.
  8. The need to ensure that any restriction on the individual’s rights or freedom of action that is involved in the exercise of the function is kept to the minimum necessary. For achieving the purpose for which the function is being exercised. Where the local authority has to take actions which restrict rights or freedoms, they should ensure that the course followed is the least restrictive necessary. Concerns about self-neglect do not override this principle.

All of the matters listed above must be considered in relation to every individual, when a local authority carries out a function as described in this guidance. Considering these matters should lead to an approach that looks at a person’s life holistically, considering their needs in the context of their skills, ambitions, and priorities – as well as the other people in their life and how they can support the person in meeting the outcomes they want to achieve. The focus should be on supporting people to live as independently as possible for as long as possible.

As with promoting wellbeing, the factors above will vary in their relevance and application to individuals. For some people, spiritual or religious beliefs will be of great significance, and should be taken into particular account. Local authorities should consider how to apply these further principles on a case by case basis. This reflects the fact that every person is different and the matters of most importance to them will accordingly vary widely.

Neither these principles nor the requirement to promote wellbeing require the local authority to undertake any particular action; the steps it takes should depend entirely on the individual’s’ circumstances. The principles as a whole are not intended to specify the activities which should take placed. Instead, their purpose is to set common expectations for how the local authority should approach and engage with people.

4. Independent Living

Although not mentioned specifically in the way that wellbeing is defined, the concept of ‘independent living’ is a core part of the wellbeing principle. Section 1 of the Care Act includes matters such as individual’s control of their day to day life, suitability of living accommodation, contribution to society – and crucially, requires local authorities to consider each person’s views, wishes, feelings and beliefs.

The wellbeing principle is intended to cover the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention). Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act. The language used in the Act is intended to be clearer, and focus on the outcomes that truly matter to people, rather than using the relatively abstract term ‘independent living’.

5. Wellbeing throughout the Care Act

Wellbeing cannot be achieved simply through crisis management; it must include a focus on delaying and preventing care and support needs, and supporting people to live as independently as possible for as long as possible.

Promoting wellbeing does not mean simply looking at a need that corresponds to a particular service. At the heart of the reformed system will be an assessment and planning process that is a genuine conversation about people’s needs for care and support and how meeting these can help them achieve the outcomes most important to them. Where someone is unable to fully participate in these conversations and has no one to help them, local authorities will arrange for an independent advocate.

In order to ensure these conversations look at people holistically, local authorities and their partners must focus on joining up around an individual, making the person the starting point for planning, rather than what services are provided by what particular agency. The chapter on Integration, Cooperation and Partnerships sets this out in more detail.

In particular, the Care Act is designed to work in partnership with the Children and Families Act 2014, which applies to 0 to 25 year old children and young people with SEN and Disabilities. In combination, the two Acts enable areas to prepare children and young people for adulthood from the earliest possible stage, including their transition to adult services. This is considered in more detail in the chapter Transition to Adult Care and Support.

Promoting wellbeing is not always about local authorities meeting needs directly. It will be just as important for them to put in place a system where people have the information they need to take control of their care and support and choose the options that are right for them. People will have an opportunity to request their local authority support in the form of a direct payment that they can then use to buy their own care and support using this information. The chapter on Information and Advice explains this in more detail.

Control also means the ability to move from one area to another or from children’s services to the adult system without fear of suddenly losing care and support. The Care Act ensures that people will be able to move to a different area without suddenly losing their care and support and provides clarity about who will be responsible for care and support in different situations. It also includes measures to help young people move to the adult care and support system, ensuring that no one finds themselves suddenly without care on turning 18.

It is not possible to promote wellbeing without establishing a basic foundation where people are safe and their care and support is on a secure footing. The Care Act puts in place a new framework for adult safeguarding and includes measures to guard against provider failure to ensure this is managed without disruption to services.

6. The Role of the Principal Social Worker in Care and Support

The purpose of this section of the guidance is to further clarify arrangements to have in place a designated principal social worker in adult care and support. Local authorities should make arrangements to have a qualified and registered social work professional practice lead in place to:

  • lead and oversee excellent social work practice;
  • support and develop arrangements for excellent practice;
  • lead the development of excellent social workers;
  • support effective social work supervision and decision making;
  • oversee quality assurance and improvement of social work practice;
  • advise the director of adult social services (DASS) and/or wider council in complex or controversial cases and on developing case or other law relating to social work practice;
  • function at the strategic level of the Professional Capabilities Framework (British Association of Social Workers).

6.1 The local authority role in supporting principal social workers

All local authorities should ensure principal social workers are given the credibility, authority and capacity to provide effective leadership and challenge, both at managerial and practitioner level and are given sufficient time to carry out their role. The principal social worker should also be visible across the organisation, from elected members and senior management, through to frontline social workers, people who use services and carers. Local authorities should therefore ensure that the role is located where it can have the most impact and profile.

Whatever arrangements are agreed locally, the principal social worker should maintain close contact with the DASS and frontline practitioners and engage in some direct practice. This can take several different forms, including direct casework, co-working, undertaking practice development sessions, mentoring, etc.

The integration of health and care and support will increasingly require social workers to lead, both in their teams and across professional boundaries, particularly in the context of safeguarding, mental health and mental capacity. Organisational models of social work have traditionally focused on managerial, as opposed to professional leadership – through their direct link to practice, principal social workers can ‘bridge the gap’ between professional and managerial responsibility, to influence the delivery and development of social work practice.

6.2 Principal social workers and safeguarding

Chapter 14 of the Care and Support Statutory Guidance endorses the: ‘Making Safeguarding Personal’ approach (see Making Safeguarding Personal). This represents a fundamental shift in social work practice in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers should have a broad knowledge base on safeguarding and Making Safeguarding Personal and be confident in its application in their own and others’ work. Local authorities should, therefore, ensure that principal social workers lead on ensuring the quality and consistency of social work practice in fulfilling its safeguarding responsibilities. In particular they should have extensive knowledge of the legal and social work response options to specific cases and in general.

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RELEVANT GUIDANCE

An Introduction to the Care Act 2014 (SCIE Video)

March 2022: A link to a video produced by SCIE containing an introduction to the Care Act 2014 has been added. See above.

1. Introduction

The Care Act 2014 came into effect on 1st April 2015.

The Care Act unites a number of different acts into one single legislative framework for adults with care and support needs and their carers.

It also introduced duties and requirements of local authorities in a number of areas, including safeguarding adults. It provides, for the first time, a legislative framework for those working in adult safeguarding. Each local authority must:

  • make enquiries, or ensure others do so, if it believes an adult is experiencing or at risk of abuse or neglect;
  • set up a Safeguarding Adults Board (SAB);
  • arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or safeguarding adults review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate adult to help them (see the chapters on Independent Advocacy and Safeguarding Adult Reviews);
  • cooperate with each of its relevant partners in order to protect adults experiencing or at risk of abuse or neglect (see the Integration, Cooperation and Partnerships chapter).

2. Statutory Guidance

The Department of Health and Social Care issued the Care and Support Statutory Guidance for local authorities and partner agencies. From 1 April 2015 Chapter 14, Safeguarding, of the guidance replaced the previous statutory guidance No Secrets: Guidance on Developing and Implementing Multi-Agency Policies and Procedures to Protect Vulnerable Adults from Abuse (Department of Health, 2000).

3. Delegated Functions

See also Delegating Local Authority Functions

The Act does not allow certain functions to be delegated; safeguarding is one of those functions. Since the local authority must be one of the members of the Safeguarding Adult Partnership (SAP) and it must take the lead role in adult safeguarding, it may not delegate these statutory functions to another party.

4. Implications for Safeguarding Practice

The Care Act signalled a major shift in safeguarding practice with a move away from a process led culture, to a person centred approach which achieves the outcomes that people want. This should avoid the rigid application of a process and encourage practitioners to use the approach which best suits the adult involved.

As everyone has different preferences, histories, circumstances and lifestyles, it is not helpful to prescribe a single process that must be followed in all circumstances whenever a concern is raised.

5. Clauses of the Care Act

Below is a summary of the main clauses and whether these are new in legislation and / or policy, or consolidation or refresh of existing legislation.

Promoting wellbeing:
Creates a new statutory principle which applies to all functions under Part 1 (including care and support and safeguarding). Whenever a local authority makes a decision about an adult, they must promote the adult’s wellbeing.

Prevention:
The local authority is required to ensure provision of preventative services which help prevent / delay development of care and support needs, or reduce such needs (including carer support needs).

Integration:
There is a duty on the local authority to carry out care and support functions with aim of integrating services with those provided by NHS or other health-related services.

Information and advice:
Provides for an information and advice service to be available to all people in the local authority area regardless of eligible care needs.

Market shaping:
There is a general duty for the local authority to promote diversity and quality in the market of local care and support providers. The local authority must ensure a range of providers is available; shaped by demands of individuals, families and carers; services are of high quality and meet needs and preferences of those wanting to access services.

Cooperation general and specific:
There is a general duty to cooperate between the local authority and other relevant authorities which have functions relevant to care and support. It also supplements the general duty to cooperate with a specific duty where cooperation is needed for an individual who has needs for care and support.

How to meet needs:
This relates to adults who need care and carers; it is an illustration of how needs could be met to ensure flexibility.

Assessment:
This creates a single legal basis that requires the local authority to carry out an assessment, referred to as ‘needs assessment,’ where it appears an adult may have care and support needs. It also sets out what is to happen where adult or a carer refuses to have a needs or carer’s assessment.

Carers assessment:
Creates a single duty to assess carers. It requires the local authority to carry out an assessment (‘carer’s assessment’) where it appears a carer may have needs for support now or in future.

Assessment regulations:
This applies to needs assessment and carers assessment, allows for regulations to specify further detail about assessment process, including requiring assessment to be appropriate and proportionate, specialist assessments, self-assessment, and considering needs of whole family.

Eligibility:
This requires LAs to determine whether a person has eligible needs after a needs assessment or carer’s assessment has been completed. It provides for regulations which set out eligibility criteria, including minimum level of eligibility at which the local authority must meet care and support needs.

Charging:
This gives the local authority a general power to charge for certain types of care and support, at its discretion.

Cap on care costs:
This allows for a limit to be established on the amount an adult be required to pay towards costs of meeting eligible needs over their lifetime. It also prevents the local authority from charging to meet needs (other than daily living costs) once the limit has been reached. It provides for annual adjustments to the cap and adult’s accrued costs in line with level of average earnings.

Financial assessment:
This requires the local authority to undertake a financial assessment if they have chosen to charge for particular service under the power in the clause above.

Duty to meet needs:
This sets out circumstances establishing entitlement to public care and support for adults who need care. It describes conditions which must be met for duty on LAs to meet eligible needs.

Power to meet needs:
This provides broad power for the local authority to meet care and support needs in circumstances where a duty to meet needs (as above) does not arise.  It also allows for the local authority to temporarily bypass carrying out assessment of needs, where care and support is needed urgently.

Duty to meet carers’ needs:
This establishes legal obligation to meet carer’s needs for support.

Exception for immigration:
This applies to adults subject to immigration control. It provides that the local authority may not meet care and support needs of such adults solely because they are ‘destitute’ or physical effects or anticipated physical effects of being destitute. If needs have arisen for other reasons (for example a disability rather than solely destitution), prohibition does not apply.

Exception for provision of healthcare services:
In meeting an adult’s or carer’s needs, the local authority may not provide healthcare services which are NHS responsibilities.

Exception for housing:
This provides the local authority may not meet adult’s care and support needs by providing general housing, or anything else required under other legislation specified in regulations.

Steps to take:
This sets out steps the local authority must take after carrying out needs assessment or carer’s assessment (and financial assessment where relevant).

Care and support / support plan:
This details requirements for inclusion in care and support plans (assessed adult) / support plan (carer).

Personal budget:
This defines the personal budget as statement and sets out financial information to be included in statement.

Review of care and support / support plan:
This requires the local authority to keep plans under review generally, and to carry out assessment where satisfied the person’s circumstances have changed. The adult can also make reasonable request to have a review.

Independent personal budget:
This establishes the concept of independent personal budgets for adults with eligible needs, who choose not to have those needs met by the local authority. An independent budget is a statement recording how much of adult’s spending on care will count towards the cap.

Care account:
This requires the local authority to keep a care account for adults whose care costs are counted towards the costs cap.

Choice of accommodation:
This provides the framework and powers to set regulations regarding choice of accommodation and other matters.

Direct Payments:
This consolidates existing legislation on direct payments. People with capacity can request a direct payment and where they meet conditions set out the local authority must provide direct payments to meet their assessed eligible needs.

Deferred payments:
This allows regulations to state when the local authority may or must enter into Deferred Payment or loan agreement which will allow people to avoid selling property or possessions.

Continuity of care:
This sets out the duties the local authority is under when an individual, and potentially their carer, notifies the local authority of the intention to move to another local authority area. It applies when a second local authority has not carried out assessment before the person moves.  It requires the second local authority to provide services based on care and support plan provided by the first local authority. The second local authority must continue to provide this care until it has undertaken its own assessment.

Ordinary residence:
This helps the local authority identify a person’s Ordinary Residence for purposes of providing care and support. It also provides a mechanism for the local authority to reclaim money spent providing care and support to someone for whom they were not in fact responsible.

Adult safeguarding:
This sets out the local authority’s responsibility for adult safeguarding: responsibility to ensure enquiries into cases of abuse and neglect; establishment of Safeguarding Adults Boards on a statutory footing; Safeguarding Adults Reviews on a statutory footing and information sharing. It repeals section 47 of the 1948 National Assistance Act, which confers power to remove someone from his or her home in certain circumstances. Also updates the duty to protect property of adults admitted to hospital or residential care.

Human rights:
This requires all care and support providers regulated by the Care Quality Commission are required to act in a way which is compatible with the European Convention on Human Rights.

Provider failure:
This sets out the duty of English local authorities when providers fail. The local authority is required to temporarily meet the adult’s needs for care and support where they are no longer met as a result of provider failing.  It applies to all individuals present in the local authority area whose needs the local authority is not already meeting, that is self-funders and those whose services funded by another local authority.

Market oversight:
This introduces duties on the Care Quality Commission to assess financial sustainability of the most difficult to replace provider, and support the local authority to ensure continuity of care when providers fail.

Transition from childhood:
This places a duty on the local authority to assess a child, young carer or child’s carer before they turn 18 – if likely to have needs once they (or the child they care for) turn 18 – in order to help them plan and if will be ‘significant benefit’.

Advocacy:
Places a duty on the local authority in specified circumstances to arrange an independent advocate to facilitate involvement of an adult or carer who is subject of assessment, care or support planning or review.

Recovery of charges, transfer of assets:
This allows the local authority to recover as debt any sums owed, such as unpaid charges and interest.

Five-yearly review:
This requires the Secretary of State for Health to review how capped cost system is operating every five years. Review results can inform decisions on changing level of cap or other system parameters, for example general living costs.

Delayed discharges:
This sets out the process for notification of discharge when an adult has care needs, and a requirement for assessment. It amends the mandatory system of fining / reimbursement, where the local authority has not carried out its’ duties by the day of discharge, to discretionary.

Mental health after-care:
This clarifies after-care services provided under section 117 of the Mental Health Act 1983 to meet need arising from / related to mental disorder of person concerned.  It aims to reduce the likelihood of deterioration in a person’s mental disorder (and therefore reduce risk of hospital admission for treatment).

Prisoners:
This sets out responsibilities for provision of care and support for adult prisoners and people residing in approved premises (including bail accommodation). Such adults should have needs assessed by the local authority, and where they meet eligibility criteria services are provided by the local authority.  Prisoners’ non-eligible needs will be met by the prison.

Registers:
This requires the local authority to continue to establish and maintain register of sight impaired people. It also enables the local authority to establish and maintain a similar register of those who need care and support or are likely to do so in future.

Guidance:
This gives the Secretary of State power to issue guidance to local authorities on how to exercise functions under the Care Act, following consultation.

Delegation:
This provides a power for local authorities to authorise a third party to carry out certain care and support functions.

Cross border placements:
This makes provision for a person ordinarily resident in England, with care and support needs and requires residential accommodation to meet those needs, to be provided with accommodation in another part of UK. It also allows for such placements in England for people ordinarily resident in Wales, or whose care and support is provided under relevant Scottish or Northern Irish legislation. Also there are similar arrangements for cross border placements not involving England i.e. Wales / Scotland, Scotland / Northern Ireland and Northern Ireland / Wales.

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RELEVANT CHAPTERS

Promoting Wellbeing

Preventing, Reducing or Delaying Needs

Making Safeguarding Personal

Amendment – In May 2023, this chapter was reviewed and updated throughout.

1. Introduction

Safeguarding adults is the term used to describe all work to help adults with care and support needs to live in safety, free from abuse and neglect.

Safeguarding requires people and organisations to work together to prevent both the risk of and the experience of abuse or neglect. At the same time, the adult’s wellbeing must be promoted including, where appropriate, having regard to their views, wishes, feelings and beliefs when deciding on any action.  This must recognise that adults are the experts in their own lives and that they sometimes have complex interpersonal relationships and may be ambivalent, unclear or unrealistic about their personal circumstances.

Organisations should always promote the adult’s wellbeing in their safeguarding arrangements. People have complex lives, and being safe means different things to different people, as well as being just one aspect of what they want to achieve. Professionals should work with the adult to establish what being safe means to them and how that can be best achieved. Professionals and other staff should not be advocating “safety” measures that do not take account of individual wellbeing (see Promoting Wellbeing chapter).

2. The Safeguarding Duty

Under section 42 of the Care Act 2014, local authorities have legal adult safeguarding duties which are to:

  • make enquiries, or cause others to do so, when a concern has been raised about an adult in its area (whether or not they are ordinarily resident in it) to establish whether an action should be taken to prevent or stop abuse or neglect.
  • This duty applies to an adult who:
    • has needs for care and support (whether or not the local authority is meeting any of those needs); and
    • is experiencing, or at risk of, abuse or neglect; and
    • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

Regardless of whether the local authority is providing any services to the adult, it must follow up any concerns about either actual or suspected abuse or neglect.

The adult experiencing, or at risk of abuse or neglect will be referred to as the ‘adult’ throughout this APPP, replacing previous terms of adult at risk or vulnerable adult.

Local authority statutory adult safeguarding duties apply equally to adults with care and support needs:

  • regardless of whether those needs are being met;
  • regardless of whether the adult lacks mental capacity or not (see Mental Capacity chapter);
  • regardless of setting, except prisons and approved premises.

Within the scope of this definition are:

  • all adults who meet the above criteria regardless of their mental capacity to make decisions about their own safety or other decisions relating to safeguarding processes and activities;
  • adults who manage their own care and support through personal or health budgets;
  • adults whose needs for care and support have not been assessed as eligible or which have been assessed as below the level of eligibility for support;
  • adults who fund their own care and support;
  • children and young people in specific circumstances as detailed below.

Outside of scope of this policy and procedure:

2.1 Children and young people

See also South Tyneside Safeguarding Children Procedures

The Children Act 1989 provides the legislative framework for agencies to take decisions on behalf of children and to take action to protect them from abuse and neglect. Young people who receive leaving or after care support from children and family services, are included in the scope of adult safeguarding, but close liaison with children and family service providers is key to establishing who is the best person to lead or support young people through adult safeguarding processes.

The Children Act 2004 places duties on a range of organisations and individuals to ensure their functions, and any services that they contract out to others, are discharged having regard to the need to safeguard and promote the welfare of children. In all adult safeguarding work, staff working with the adult should establish whether there are children in the family and whether checks should be made on children and young people who are part of the same household, irrespective of whether they are dependent on care either from the adult, or the person alleged to have caused harm. See Whole Family Approach chapter.

Children and young people may be at greater risk of harm or be in need of additional help in families where adults have mental health problems, misuse substances or alcohol, are in a violent relationship, have complex needs or have learning difficulties.’ For further information see Working Together to Safeguard Children (Department for Education).

Abuse within families reflects a diverse range of relationships and power dynamics, which may affect the causes and impact of abuse. These can challenge professionals to work across multi-disciplinary boundaries in order to protect all those at risk. In particular staff may be assisted by using domestic abuse risk management tools as well as safeguarding risk management tools. Staff providing services to adults, children and families should have appropriate training whereby they are able to identify risks and abuse to children and vulnerable adults.

In respect of young carers, the Care Act 2014, alongside the Children and Families Act 2014, offers a joined up legal framework to identify young carers and parent carers and their support needs. Both Acts have a strong emphasis on outcomes and wellbeing.

2.1.1 Transition

The Care Act 2014 places a duty on local authorities to conduct transition assessments for children, children carers and young carers where there is a likely need for care and support after the child in question turns 18 and a transition assessment would be of significant benefit. See also Transition to Adult Care and Support chapter.

Where there are ongoing safeguarding issues for a young person and it is anticipated that on reaching 18 years of age they are likely to require adult safeguarding, safeguarding arrangements should be discussed as part of transition support planning and protection. Conference chairs and Independent Reviewing Officers, if involved, should seek assurance that there has been appropriate consultation with the young person by adult social care and invite them to any relevant conference or review. Clarification should be sought on:

  • what information and advice the young person has received about adult safeguarding;
  • the need for advocacy and support;
  • whether a mental capacity assessment is needed and who will undertake it.
  • if best Interest decisions need to be made
  • whether any application needs to be made to the Court of Protection.
  • If the young person is not subject to a plan, it may be prudent to hold a professionals meeting.

2.1.2 Children and young people who abuse

If a child or young person is causing harm to an adult covered by the adult safeguarding procedures, action should be taken under these procedures, and a referral and close liaison with children’s services should take place.

Violence towards parents and other relatives (for example, grandparents, aunts, uncles) some of whom, may be adults experiencing or at risk of abuse or neglect, can be carried out by adults and by young people and children, some of which can cause serious harm or death.

2.2 Carers and safeguarding

Circumstances in which a carer could be involved in a situation that may require a safeguarding response includes when:

  • a carer may witness or speak up about abuse or neglect;
  • a carer may experience intentional or unintentional harm from the adult they are trying to support or from professionals and organisations they are in contact with; or,
  • a carer may unintentionally or intentionally harm or neglect the adult they support on their own or with others.

Where there is intentional abuse, adult safeguarding under the Care Act should always be considered. See Carers chapter.

3. Who Abuses and Neglects Adults?

Anyone can carry out abuse or neglect, including:

  • spouses / partners;
  • other family members;
  • neighbours or friends;
  • friends;
  • a paid or volunteer carer;
  • acquaintances;
  • local residents;
  • people who deliberately exploit adults they perceive as vulnerable to abuse;
  • paid staff or professionals;
  • volunteers and strangers.

Abuse can happen anywhere, for example in someone’s own home, in a public place, in hospital, in a care home or in college. It can take place where an adult lives alone, or with others.

4. Principles of Adult Safeguarding

There are six principles which apply to all sectors and settings including care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

The principles should inform the ways in which professionals and other staff work with adults. The principles can also help the Safeguarding Adults Board and partner organisations more widely, by using them to examine and improve their local arrangements.

Empowerment: People are supported and encouraged to make their own decisions and give informed consent. People should always be treated with dignity and respect, and staff should work alongside them to ensure they receive quality, person-centred care which ensures they are safe on their own terms.

“I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

Prevention: Prevention and early support are key to effective safeguarding. The principle of prevention recognises the importance of taking action before harm occurs and seeks to put mechanisms in place so they don’t reoccur.

“I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionality: This means deciding the least intrusive response appropriate to the risk presented.

“I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”

Protection: This involves delivering support and representation for those in greatest need who may not be able to do it for themselves.

 “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want.”

Partnership: Effective safeguarding cannot be delivered in isolation. Local solutions are best achieved through services working with their communities, professionals and services as a whole.

“I know that staff treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”

Accountability: This recognises the importance of being open, clear and honest in the delivery of safeguarding, and ensuring there are systems in place to hold practitioners and services to account.

“I understand the role of everyone involved in my life and so do they.”

5. Aims of Adult Safeguarding

The aims of adult safeguarding are to:

  • prevent harm and reduce risk of abuse and neglect for those adults with care and support needs;
  • stop abuse or neglect wherever possible;
  • safeguard adults in a way that enhances individual choice and control, as part of improving their quality of life, ;
  • work alongside the adult to identify strengths-based and outcomes-focused solutions;
  • raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect;
  • provide information and support to help people understand abuse, how to stay safe and how to raise concerns;
  • address the causes of abuse.

Safeguarding is not a substitute for:

  • providers’ responsibilities to provide safe and high quality care and support;
  • commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;
  • the Care Quality Commission (CQC) ensuring regulated providers comply with the fundamental standards of care or by taking enforcement action; and
  • the core duties of the police to prevent and detect crime and protect life and property.

6. Making Safeguarding Personal

See also Making Safeguarding Personal chapter.

Making Safeguarding Personal is a person-centred approach that promotes a commitment to improving outcomes for adults experiencing, or at risk of, abuse or neglect. The key focus is recognising that people are experts in their own lives and that developing a real understanding of what people wish to achieve will give the person greater control over their lives.

It involves working with the adult (and their representatives) to determine how best their outcomes might be realised and regularly evaluating the extent of which desired outcomes have been met. This approach involves adults being encouraged to define their own meaningful improvements to change their circumstances and then to be involved throughout the safeguarding process, support planning and response.

Adults need to be encouraged to make their own decisions as far as practicably possible and are provided with support and information to empower them to do so. This approach recognises that adults have a general right to independence, choice and self-determination including control over information about themselves.

Making safeguarding personal It engages the adult in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.

Staff should work to deliver effective safeguarding n line with the six principles of safeguarding (see Section 2, Principles). They should ensure that the adult has accessible information so that they can make informed choices about safeguarding: what it means, risks and benefits and possible consequences.

7. Personal Budgets and Personal Health Budgets

Regardless of the adult’s preferred method of managing a personal budget, the local authority retains its duty of care with regard to the adult and their protection from abuse. The Integrated Care Board (ICB) also has responsibilities around the provision of personal health budgets.

Personalised care planning can enhance good safeguarding practice, bringing in people’s own resources and intelligence. Through empowering adults, organisations can help raise awareness of what is acceptable and use information from adults and their families to identify potential problems with providers.

The kind of support available to adults managing their own care and support includes advice on:

  • managing money;
  • safer recruitment;
  • safeguarding and dignity;
  • what to expect from services and individuals;
  • using approved or accredited providers of employment services;
  • contractual issues;
  • who to contact if things go wrong;
  • guidance on mental capacity issues;
  • guidance on deputyship and Lasting Power of Attorney.

8. Raising Awareness

Partners should plan regular public awareness campaigns as these can make a significant contribution to the prevention of abuse. Such campaigns are more effective when supported by information and advice about where to get help, and when there is effective training for staff and services to respond. See also Safeguarding Leaflets and Safeguarding Posters.

9. NHS England -Serious Incidents

The NHS England Serious Incident Framework should be read in conjunction with the Never Events Policy and Framework. The Serious Incident Framework is not a substitute for safeguarding. Where safeguarding is indicated a safeguarding referral must be made, however a root cause analysis under the Serious Incident Framework may be considered an appropriate response to a safeguarding enquiry.

Broadly speaking there are three scenarios:

  1. NHS identifies a safeguarding concern, for example through staff at Accident and Emergency seeing signs of physical abuse. This may warrant a safeguarding referral to the Local Authority but would not be routinely recorded as an SI.
  2. If there are allegations against healthcare staff within the provider of a service to adults, then a safeguarding referral and SI would need to be declared. Equally if there is patient against patient abuse.
  3. Lastly, there are incidents that are reported on STEIS that are not safeguarding issues, for example a pressure ulcer that was unavoidable (see the chapter on Pressure Areas and Safeguarding). Investigations will still be undertaken but without referral for a safeguarding. This is obviously dependent on the situation.
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RELEVANT CHAPTER AND SECTION

Introduction

Using this APPP Resource

1. Aim

This Adults Policies, Procedures and Practice (APPP) Resource aims to provide practitioners working across South Tyneside with the tools they need to safeguard adults from abuse and neglect.

2. Structure

The document is structured into the following sections and appendices:

See also Forms, Leaflets and Posters for relevant forms.

See also Local Contacts for details of local teams and organisations.

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The following partners have contributed to the development of the procedural framework as members of South Tyneside Safeguarding Adults Board

  • South Tyneside Council
  • South Tyneside Clinical Commissioning Group
  • Northumbria Police
  • South Tyneside NHS Foundation Trust
  • Northumberland Tyne and Wear NHS Foundation Trust
  • Northumbria Community Rehabilitation Company
  • Tyne and Wear Fire and Rescue Services
  • Northumbria Probation Trust
  • South Tyneside Homes
  • North East Ambulance Service
  • South Tyneside Community Safety Partnership

We wish to thank all of the individuals, statutory and non-statutory representatives and agencies whose expertise and time have made this document possible.  In particular we wish to thank the original author of the Pan-London procedures, Lorraine Stanforth, on which these procedures were first based.

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RELEVANT CHAPTERS

Context, Principles and Values

Safeguarding: What is it and Why does it Matter?

1. Scope of this Adult Policies, Procedures and Practice Resource

This Adult Policies, Procedures and Practice (APPP) Resource covers:

  • the legislative requirements and expectations on individual services to safeguard and promote the wellbeing of adults in the exercise of their respective functions, relating to adults with needs for care and support and carers; and
  • a framework for South Tyneside Safeguarding Children and Adults Partnership to monitor the effective implementation of policies and procedures.

2. Safeguarding Duty

The safeguarding duties apply to an adult who:

  • has needs for care and support (whether or not the local authority is meeting any of those needs)
  • is experiencing, or at risk of, abuse or neglect
  • as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect

The adult experiencing, or at risk of abuse or neglect will hereafter be referred to as ‘the adult’ throughout the APPP.

3. Supplementary Guidance and Information

The chapters in this APPP should be read in conjunction with:

This APPP embeds relevant national documents including Safeguarding Children, Young People and Adults in the NHS Accountability and Assurance Framework which outlines the roles and responsibilities of the health service. It also takes account of national initiatives about housing and safeguarding and draws on the commitment for organisations to work together championed by the Association of Directors of Adult Social Services.

It is steered by the personalisation of health and adult social care through the national Making Safeguarding Personal programme (see Making Safeguarding Personal chapter). This arose following feedback from many people who had used safeguarding services, reporting that they felt they were being driven through a process and felt out of control. The shift in culture, by developing a personalised approach to supporting people, is a shared vision for all organisations working with adults who may be or are at risk of abuse and neglect.

The Mental Capacity Act 2005 (MCA) is pertinent throughout the APPP and staff should ensure that all decisions and actions are taken in line with the requirements of the Act.

Reference to key documents and resources are made throughout in particular:

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Click here to view useful References to accompany chapters in this APPP.

See also Resources, for a further information.

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South Tyneside Safeguarding Adults Thresholds Guidance Tool (2023)

The guidance tool supports practitioners, partners and providers, working within the adult sector, to report and respond to concerns at the appropriate level and to have a consistency of approach across agencies.

The guidance should be used to:

  • Help determine a consistent approach to identifying what concerns may require a response under the safeguarding process.
  • Support decision making when alternative processes should be used.

The guidance is not a substitute for professional judgement but should be used to assist decision making and to support professional judgement.

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RELEVANT CHAPTERS

South Tyneside Safeguarding Adults Board Strategic Plan

Making Safeguarding Personal

South Tyneside Multi Agency Information Sharing Agreement

1. South Tyneside Safeguarding Adults Board

All local authorities must establish a Safeguarding Adults Board (SAB), as set out in the Care Act 2014. The Act gives the local SAB three specific duties, namely:

  • Publish a strategic plan for each financial year that sets out how it will meet its main objective and what each member is to do to implement that strategy. In developing the plan, it must consult the Local Healthwatch organisation and involve the community.
  • Publish an annual report detailing what the SAB has done during the year to achieve its objective and what it and each member has done to implement its strategy as well as reporting the findings of any SARs including any ongoing reviews
  • Decide when a Safeguarding Adult Review (SAR) is necessary, arrange for its conduct and if it so decides, to implement the findings.

The Social Care Institute for Excellence Safeguarding Adults Board Checklist and Resources provides a comprehensive narrative and account of the roles and responsibilities of the SAB.

2. Links to other Local Partnerships

The Safeguarding Adults Board has links to:

  • South Tyneside Community Safety Partnership;
  • Health and Wellbeing Board;
  • Quality Surveillance Groups;
  • North East and North Cumbria Integrated Care Board (ICB); and
  • Overview and Scrutiny Committee (OSC).

2.1 Community Safety Partnerships

Community safety partnerships (CSPs) are made up of representatives from the ‘responsible authorities’, which are the:

  • police;
  • local authority;
  • fire and rescue authorities;
  • probation;
  • health

The responsible authorities work together to protect their local communities from crime and to help people feel safer. They work out how to deal with local issues like anti-social behaviour, drug or alcohol misuse and re-offending. They annually assess local crime priorities and consult partners and the local community about how to deal with them.

2.2 Safeguarding Children Partnership

The Children Act 2004 requires each local authority to establish a Safeguarding Children Partnership for their area and specifies the organisations and individuals (other than the local authority) that should be represented on it. This is called the South Tyneside Safeguarding Children Partnership. The police and health are core members.

2.3 Health and Wellbeing Boards

The Health and Social Care Act 2012 establishes health and wellbeing boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. They are an important feature of the NHS reforms and are key to promoting greater integration of health and local government services. Boards strike a balance between status as a council committee and role as a partnership body.

2.4 Quality Surveillance Groups

Quality Surveillance Groups (QSGs) are primarily concerned with NHS commissioned services: those services that are funded by the NHS, including relevant public health services.

The QSGs are supported by NHS England. They provide an open forum for local supervisory, commissioning and regulatory bodies to share intelligence and give the opportunity to co-ordinate actions to ensure improvements in services. Its purpose is to ensure quality by early identification of risk, and; reduce the burden of performance management and regulation on providers. The strategic links with the Safeguarding Adults Board provides further opportunity to escalate concerns and share risks, and take a sub region view of quality concerns.

3. Senior Strategic Roles

Under the Care Act 2014 the Safeguarding Adults Board should include the local authority, the North East and North Cumbria Integrated Care Board (formerly South Tyneside Clinical Commissioning Group) and the police. The chief officers must sign off their organisation’s contributions to the strategic plan and annual reports. Chief officers should receive regular briefings of case law from the Court of Protection and the High Courts. See also Safeguarding Adults: Roles and Responsibilities in Health and Care Services (Care Quality Commission et al).

4. Role and Function of the Police

Although the police are a mandatory member of the Safeguarding Adults Board, they are not an agency responsible for the provision of care. The police role in adult safeguarding is related to their core policing duties which are to:

  • prevent and detect crime;
  • keep the peace;
  • protect life and property.

5. Other Organisations with Adult Safeguarding Responsibilities

5.1 Care Quality Commission

Safeguarding is a key priority for the Care Quality Commission (CQC) and people who use services are at the heart of their policy. Their work to help safeguard children and adults reflects both their focus on human rights and the requirement within the Health and Social Care Act 2012 to have regard to the need to protect and promote the rights of people who use health and social care services. Health and adult social care regulated services all have a key role in safeguarding vulnerable children and adults at risk. The CQC will monitor how these roles are fulfilled through its regulatory processes by assessing the quality and safety of care provided based on the things that matter to people. It does this by using five key lines of enquiry to ensure that health and social care services provide people with safe, effective, caring, responsive and well led services. Specifically, it considers safeguarding within the ‘Safe’ key line of enquiry.

The CQC will share with local partners, where they are not already aware, the safeguarding information that it receives so that they can take the appropriate action to protect the individual. Safeguarding information is also used within its intelligent monitoring systems in order to assess its impact upon the service and the associated level of risk. This information is then used to inform the CQC inspection process. Although there are differences in the statutory basis and policy context between safeguarding children and adult safeguarding, the CQC have the same approach with an overarching objective of enabling people to live a life free from abuse. The CQC also has a role in health and safety in collaboration with the Health and Safety Executive and local authorities.

5.2 Commissioners

Commissioners from the North East and North Cumbria Integrated Care Board, local authority, and NHS England are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they procure and ensure that contracts have explicit clauses that holds Providers to account for preventing and dealing promptly and appropriately with any concerns of abuse and neglect. Commissioners have a shared and common vision to prevent, reduce and delay the need for care and support. For safeguarding this means, ensuring that people have easy access to information and advice, and early intervention services. Increasingly there is joint commissioning to meet the growing needs within a financial climate of austerity, with greater emphasis on prevention and early intervention. This is in line with the safeguarding principles.

5.3 Community Nursing

Community nurses largely provide treatment in individual’s own homes which includes care homes. A high proportion of people they visit are adults at risk of abuse or neglect by the fact that they have care and support needs and many cannot protect themselves. Community nurses are trained to recognise the signs of abuse and neglect, and to raise their concerns through their line manager, or directly with local authorities. The most common concerns raised relate to neglect.

Through holistic assessments, nursing staff may identity that the person is not getting their health or social care needs met. This could be because of gaps in what is provided by the statutory agencies, or because of decisions made on their behalf by family or friends. Nurses are in a good position to identify possible abuse or neglect particularly financial abuse or domestic abuse, including where this could be a response to the pressures of caring.

Pressure ulcer management and quality of care in care settings, are further areas that nursing staff are able to use their clinical judgements about whether or not abuse and neglect has or is likely to arise. Because community nurses make repeated visits to their patients, they are also in a good position to review risks and the effectiveness of safeguarding plans in response to concerns.

5.4 The Coroner

Coroners are independent judicial officer holders who are responsible for investigating violent, unnatural deaths or deaths of unknown cause, and deaths in custody or otherwise in state detention, which must be reported to them. The Coroner may have specific questions arising from the death of an adult. These are likely to fall within one of the following categories:

  • where there is an obvious and serious failing by one or more organisations;
  • where there are no obvious failings, but the actions taken by organisations require further exploration / explanation;
  • where a death has occurred and there are concerns for others in the same household or setting (such as a care home);
  • deaths that fall outside the requirement to hold an inquest but follow-up;
  • enquiries / actions are identified by the Coroner or his/ her officers.

5.5 Crown Prosecution Service

The CPS is the principal public prosecuting authority for England and Wales and is headed by the Director of Public Prosecutions. Support is available within the judicial system to support adults at risk to enable them to bring cases to court and to give best evidence. If a person has been the victim of abuse that is also a crime, their support needs can be identified by the police, the CPS and others who have contact with the adult. Witness Care Units exist in all judicial areas and are run jointly by the CPS and the police.

5.6 Court of Protection

The Court of Protection deals with decisions and orders affecting people who lack capacity. The court can make major decisions about health and welfare, as well as property and financial affairs. The court has powers to:

  • decide whether a person has mental capacity to make a particular decision for themselves;
  • make declarations, decisions or orders on financial and welfare matters affecting individuals who lack capacity to make such decisions;
  • appoint deputies to make decisions for persons lacking capacity to make those decisions;
  • decide whether a lasting power of attorney or an enduring power of attorney is valid;
  • remove deputies or attorneys who fail to carry out their duties.

In most cases decisions about personal welfare will be able to be made legally without making an application to the court, as long as the decisions are made in accordance with the core principles set out in the Mental Capacity Act 2005 and the Best Interests Checklist and any disagreements can be resolved informally. However, it may be necessary and desirable to make an application to the Court in a safeguarding situation where there are:

  • particularly difficult decisions to be made;
  • disagreements that cannot be resolved by any other means;
  • ongoing decisions needed about the personal welfare of a person who lacks capacity to make such decisions for themselves;
  • matters relating to property and/or financial issues to be resolved;
  • serious healthcare and treatment decisions, for example, withdrawal of artificial nutrition or hydration;
  • concerns that a person should be moved from a place where they are believed to be at risk;
  • concerns or a desire to place restrictions on contact with named individuals because of risk or where proposed adult safeguarding actions may amount to a deprivation of liberty outside of a care home or hospital.

5.7 Environmental Health

Responsible for health and safety enforcement in businesses, investigating food poisoning outbreaks, pest control, noise pollution and issues related to health and safety. Local authorities are responsible for the enforcement of health and safety legislation in shops, offices, and other parts of the service sector.

5.8 General Practitioners

GPs have a significant role in safeguarding adults. This includes:

  • making a referral to a safeguarding adults referral point should they suspect or know of abuse and neglect in line with these procedures;
  • playing an active role in planning meetings and safeguarding plans;
  • supporting safeguarding actions where there is organisational abuse and / or neglect.

5.9 Health Providers

All health providers are responsible for the safety and quality of services. Health providers are required to demonstrate that they have safeguarding leadership, expertise and commitment at all levels. Health providers are required to have effective arrangements in place to safeguard adults at risk of abuse or neglect and to assure themselves, regulators and their commissioners that these are effective and meet the required standards. Safeguarding arrangements mirror those of the North East and North Cumbria Integrated Care Board. All health service providers are required to be registered with the CQC.

5.10 Named Professionals (Health Providers)

Named professionals have a key role in promoting good professional practice within their organisation, supporting the local safeguarding system and processes, providing advice and expertise for fellow professionals, and ensuring safeguarding training is in place. They should work closely with their organisation’s safeguarding lead, designated professionals and the Safeguarding Adults Board. Safeguarding adult leads support and advise commissioners on adult safeguarding within contracts and commissioned services. They also have responsibility to improve systems and embed referral routes for adults at risk across the health system. They provide a health advisory role to the Safeguarding Adults Board, supporting the North East and North Cumbria Integrated Care Board who sits on the SAB.

5.11 Healthwatch

Healthwatch England is the national consumer champion in health and care and must be consulted on the strategic plan. It has significant statutory powers to ensure the voice of the consumer is strengthened. It challenges and holds to account commissioners, the Regulator and Providers of health and social care services. Healthwatch

  • Identifies common problems with health and social care based on people’s experiences
  • Recommends changes to health and social care services that they know will benefit people
  • Hold those services and decision makers to account and demands action.

As a statutory watchdog, their role is to ensure that health and social care services, and the government, put people at the heart of their care.

5.12 Housing providers

The Care Act states that a Local Authority must consider cooperating with Social Housing Providers in order to exercise its care and support duties. An authority must do this in particular when protecting adults at risk of harm and neglect and when identifying and sharing lessons to be learned from cases of serious abuse or neglect.

5.12.1 Social housing providers 

Registered with, and regulated, by the Homes England and Regulator of Social Housing. They are also known as registered providers of social housing (RPs) or registered social landlords (RSLs). They include local authority landlords, arm’s length management organisations (ALMOs) that manage council housing stock, private for-profit or not-for-profit housing providers, and voluntary sector providers such as alms houses. Most not-for-profit RPs are also known as housing associations.

RPs provide a wide range of housing and housing-related services. They provide much of the supported accommodation in England, such as sheltered housing, care homes, supported living scheme housing, extra care schemes, hostels, foyers for young people, domestic abuse refuges, etc.

5.12.2 Implementing the principles

Beyond the core service of providing housing, RPs may also engage in initiatives that enhance their customers’ wellbeing and create sustainable communities, such as: housing support, community safety, better neighbourhoods, responding to anti-social behaviour, employment & training, domestic abuse, self-neglect and hoarding, fraud awareness, debt & financial inclusion, reducing isolation, tenancy sustainment support, etc.

Local authorities must take into account that the suitability of accommodation is a core component of wellbeing and good housing provision can variously promote that wellbeing. This includes minimising the circumstances, such as isolation, which can make some adults more vulnerable to abuse or neglect in the first place. The nature and diversity of RPs’ work, therefore, can mean that their staff are often well placed to:

Have a good knowledge of the individual and the communities with whom they work:

  • be working with persons who are unable to protect themselves from abuse or neglect due to their care and support needs, but who are not already known to adult social care;
  • identify individuals experiencing or at risk of abuse or neglect and raise concerns;
  • be the first professionals to whom individuals might first disclose abuse or neglect concerns;
  • be the only professionals working with the adult;
  • provide essential information and advice regarding the adult;
  • contribute actively to person-led safeguarding risk assessments and arrangements to support and protect an individual, where appropriate;
  • carry out a safeguarding enquiry, or elements of one;
  • work with agencies to support someone who is hoarding;
  • work together with agencies to resolve issues with someone who refuses support or self-neglects, or when someone may not be eligible for a safeguarding service or social care support;
  • work with local authorities to promote safeguarding awareness, information and prevention campaigns;
  • be instrumental in helping a local authority to successfully exercise its safeguarding and wellbeing duties.

Housing providers should ensure that they develop a safeguarding culture through:

  • partnership and leadership commitment and ownership of safeguarding responsibilities;
  • policies or guidance that promote the 6 principles of adult safeguarding;
  • policies that reflect the adult safeguarding framework set out by the Safeguarding Adults Board;
  • staff being vigilant about adult safeguarding concerns;
  • learning and development for staff on adult safeguarding and the MCA enabling them to fulfil their roles and responsibilities;
  • sharing information appropriately to safeguard adults at risk and engaging with information sharing agreements where required;
  • developing inter-housing networks as well as multi-agency mechanisms.

5.13 North East Ambulance Service (NEAS)

There are a number of ways in which North East Ambulance Service staff may receive information or make observations which suggest that an adult has been abused, neglected or is at risk of abuse and neglect. At a strategic level the six safeguarding principles are embedded into its business plans and aims to translate them into practice by using them to shape strategic and operational safeguarding arrangements.

  • Use integrated governance systems and processes to prevent abuse occurring and respond effectively where harm does occur
  • Work to support the Safeguarding Adults Board by providing policy updates, and its annual report to support, patients and community partners to create safeguards.
  • Provide leadership for safeguard adults policies
  • Ensure accountability and use learning within the service and the partnership to bring about improvement

5.14 Tyne and Wear Fire and Rescue Service

Tyne and Wear Fire and Rescue Service (TWFRS) staff become aware of safeguarding concerns in a number of ways, not only when responding to emergency calls, but during community safety preventative work such as during home fire safety visits. TWFRS staff receive safeguarding training to enable them to identify whether an adult has been, or is at risk of being abused and/or neglected, and are aware of how to report concerns.

5.15 Probation Service 

The probation service are responsible for supervising offenders on licence and community orders, and/ or those subject to Multi-Agency Public Protection Arrangement (MAPPA). This work includes preparing pre-sentence reports for courts, preparing parole reports, supervising offenders in approved premises, and delivering sex offender treatment programmes, support to victims of serious violent and sexual offences through the Victim Liaison Unit.

The probation service has a remit to demonstrate a continuous focus on assessment and risk of harm, to protect adults at risk, children and young people, and victims of crime. One of their key objectives is to evidence that routine checks are completed (with appropriate agencies) and information accessed is used to inform the assessment and management of risk in all cases. There is an emphasis on partnership working across South Tyneside at a strategic and local level.

The probation service works in partnership with other agencies through the Multi Agency Public Protection Arrangements (MAPPA). The purpose of the MAPPA framework is to reduce the risks posed by sexual and violent offenders in order to protect the public. The responsible authorities in respect of MAPPA are the police, prison and the probation service and they  have a duty to ensure that a local MAPPA is established and the risk assessment and management of all identified MAPPA offenders is addressed through multi-agency working.

5.16 NHS England 

The general function of NHS England is to promote a comprehensive health service to improve the health outcomes for people in England. NHS England has a statutory requirement to oversee assurance of Integrated Care Boards in their commissioning role.

The mandate from Government sets out a number of objectives which NHS England is legally obliged to pursue. The objectives relevant to safeguarding are:

  • continuing to improve safeguarding practice in the NHS;
  • contributing to multi-agency family support services for vulnerable and troubled families; and
  • contributing to reducing violence, in particular by improving the way the NHS shares information about violent assaults with partners, and supports victims of crime.

They have two distinct safeguarding roles:

  1. Direct commissioning: Commissioning primary care, specialised services, health care services in justice, health services for armed forces and families and some public health services. As a commissioner of health services, NHS England also needs to assure itself that the organisations from which it commissions have effective safeguarding arrangements in place.
  2. Assurance and system leadership: discharged through the Chief Nursing Officer (CNO) who has a national safeguarding leadership role. The CNO is the Lead Board Director for safeguarding and has a number of forums through which to gain assurance and oversight, particularly through the NHS England National Safeguarding Steering Group

In addition, NHS England is responsible for ensuring, in conjunction with Clinical Leads from North East and North Cumbria ICB, that there are effective arrangements for the employment and development of a named GP/named professional capacity for supporting Primary Care within the local area

5.17 Safeguarding Forum

Integrated Care Boards (ICBs) and NHS England provide support to safeguarding professionals to be able to access the widest possible expertise to support improving safeguarding practice across the NHS system. In order to support this, NHS England have established Safeguarding Forums within each region. For South Tyneside locality this forum is hosted by NHS England Cumbria and North East NHS England.

5.18 Office of the Public Guardian (OPG)

The OPG was established under the Mental Capacity Act 2005 to support the Public Guardian and to protect people lacking capacity by:

    • setting up and managing separate registers of lasting powers of attorney, and of court appointed deputies;
    • supervising deputies;
    • sending Court of Protection visitors to visit individuals who lack capacity and also those for whom it has formal powers to act on their behalf;
    • receiving reports from attorneys acting under lasting powers of attorney and deputies;
    • providing reports to the Court of Protection;
  • dealing with complaints about the way in which attorneys or deputies carry out their duties.

The OPG can carry out an investigation into the actions of a deputy, of a registered attorney (lasting powers of attorney or enduring powers of attorney) or someone authorised by the Court of Protection to carry out a transaction for someone who lacks capacity, and report to the Public Guardian or the court.

5.19 Providers

All commissioned service provider organisations should produce their own guidelines that are consistent with the multi-agency Safeguarding Adults policy and procedures. These should set out the responsibilities of staff, clear internal reporting procedures and clear procedures for reporting to the local Safeguarding Adults process. In addition, provider organisations’ internal guidelines should cover:

5.20 Public Health 

The UK Health Security Agency is responsible for protecting every member of every community from the impact of infectious diseases, chemical, biological, radiological and nuclear incidents and other health threats. Alongside this, the Office for Health Improvement and Disparities provides a focus on improving the nation’s health so that everyone can expect to live more of life in good health, and on levelling up health disparities to break the link between background and prospects for a healthy life.

5.21 Trading Standards

Trading Standards provide advice for businesses and is responsible for enforcing laws covering the safety, descriptions and pricing of products and services. Trading Standards officers have particular skills in dealing with fraud, tricks and scams

5.22 Voluntary or community sector

The Voluntary and Community Sector (also non-profit sector or ‘not-for-profit’ sector) is the duty of social activity undertaken by non-statutory organisations. The Voluntary and Community Sector should include safeguarding adults within their induction programmes.

Safeguarding should be integral to policies and procedures and policies, for example:

  • staff and volunteers are aware of what abuse is and how to spot it;
  • having a clear system of reporting concerns as soon as abuse is identified or suspected;
  • respond to abuse appropriately respecting confidentiality;
  • prevent harm and abuse through rigorous recruitment and interview process.

Voluntary and community organisations can promote safeguarding and support statutory organisations through consultations on policy and developments, work on prevention strategies and promoting wider public awareness. South Tyneside Safeguarding Adults Board has the discretion to invite membership from the voluntary and community sector.

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RELEVANT CHAPTER

South Tyneside Safeguarding Adults Structures and Organisations

1. Introduction

This section covers the responsibility of organisations, with leadership from the South Tyneside Safeguarding Adults Board, to support staff and to ensure that there is a well trained workforce equipped to safeguard adults who are experiencing or at risk of abuse and neglect. These responsibilities are highlighted in the Adult Safeguarding Improvement Tool.

Workforce development is a key enabler of change to meet the standards set out. The tool enables effective scrutiny of safeguarding work at all levels and across all agencies with safeguarding responsibilities in the context of Making Safeguarding Personal and ensuring greater independence and choice for users of services. The shift in culture and practice, in response to what we now know about what makes safeguarding more or less effective from the perspective of the person being safeguarded, is the greatest challenge for organisations.

For agencies involved in making Section 42 enquiries, there may be particular cultural and learning and development needs including improving skills in:

  • communication with a wider range of people;
  • risk assessment – making complex interpretations of information about the safety and wellbeing of people in order to balance professional assessment of risk with the rights of adults at risk to determine their own safeguarding outcomes.

A positive workplace culture (key in preventing abuse in the provision of care) should be developed through strong leadership and management.  Changes in the way that the workforce responds to concerns about abuse or neglect may mean that some organisations may have to assess their capacity to meet their safeguarding responsibilities.

2. Prevention

Knowing how to stop abuse and neglect and prevent it happening in the first place should be at the forefront of safeguarding developments. Staff need to be mindful of potential risks and discuss these with people who might be at risk of abuse or neglect at every opportunity, giving them information and support that enables them to make informed choices. Awareness campaigns for the general public and multi-agency training for all staff might contribute to achieving these objectives

Dealing with the variety of need is better achieved by professionals understanding the underlying principles of good practice in assessment, risk management and safeguarding work, and developing the expertise to apply them throughout.

3. Safe Organisations

A safe organisation ensures that its governing body, all of its employees, commissioned or contracted agents and volunteers or adult participants are aware of their responsibilities to safeguard children and adults. This includes:

  • safer recruitment / selection practice;
  • good induction systems;
  • ongoing training / updates for staff (and others) in minimum standards in adult safeguarding;
  • clear access to guidance / procedures for both children and adult safeguarding;
  • awareness of local protocols and systems for information sharing and referral;
  • developing a listening culture to adults with an open mind and promoting person-centred;
  • clear and accessible complaints and whistleblowing procedures;
  • adherence to agreed local procedures for responding to concerns and allegations of abuse and neglect of harm by persons in positions of trust;
  • independent advocacy and support;
  • good record keeping;
  • a formal and independent review process for learning from serious incidents, SARs and other reviews that may impact on adult safeguarding;
  • regular audits of the above to ensure compliance;
  • leadership / accountability in a named senior manager and clear access to specialist advice about adult safeguarding (externally if not available within the organisation).

4. Recruitment and Barring

All organisations that employ adults or volunteers to work with children or vulnerable adults should adopt a consistent thorough process of safer recruitment to ensure those recruited are the best candidates for the role and are suitable to work with vulnerable groups. The Disclosure and Barring Service provides Criminal Records Checking and Barring Functions to help employers make safe recruitment decisions. In addition, recruitment processes should evidence:

  • right to work in the UK;
  • application process (forms, supporting statements, curriculum vitae, interview and selection);
  • qualifications;
  • verifiable references.

5. Related Issues

Rehabilitation of Offenders Act 1974: people working with children or vulnerable adults are required to reveal all convictions, both spent and unspent. Registration with professional bodies: if registration with a professional body is a condition of employment, staff are responsible for maintaining their registration. Employers should carry out compliance audits as part of their safeguarding quality assurance measures.

6. Induction

It is important for all workers to know exactly what is expected of them in their role. Employers should ensure that there is an agreed induction period that covers cultures, standards, human resources policy and procedures, terms and conditions. Additionally, staff should be supported through this period to understand their safeguarding role and responsibility.

7. Professional Development

For frontline workers in health and social care, the Care Certificate (Skills for Care) sets out the minimum standards required and aims to ensure that workers have the same introductory skills, knowledge and behaviours to provide compassionate, safe and high quality care and support. It is designed for new staff, but also offers opportunities for existing staff to refresh or improve their knowledge. It was developed jointly by Skills for Care, Health Education England and Skills for Health.

The Care Certificate:

  • links to National Occupational Standards and units in qualifications;
  • gives workers a good basis from which they can further develop their knowledge and skills.

For managers in adult social care there are also Manager Induction Standards (Skills for Care).

Assessed and Supported Year in Employment (ASYE) is designed to help newly qualified social workers (NQSWs) to develop their skills, knowledge and capability. It aims to strengthen their professional confidence. It aims to provide them with access to regular and focused support during their first year of employment. Their safeguarding skills should be developed as part of this process.

8. Learning and Development

South Tyneside Safeguarding Adults Board will lead and each organisation will determine their own Learning and Development activities which may include seminars on specific topics, practice development forums whereby staff learn from audits and performance data, and peer challenges as well as formal training. Learning and Development activity should be informed by learning from SARs and a shared approach to learning.

9. Training

All organisations need to ensure that staff and volunteers have access to training and continuous professional development that is appropriate to their level of responsibility. Safeguarding adults and mental capacity training is mandatory in most organisations. It is suggested that at a minimum it should cover:

  • recognising different types of abuse and how to raise a concern;
  • mental capacity, consent and best interest;
  • Making Safeguarding Personal;
  • risk and how to manage it;
  • duties under Section 42 on enquiries;
  • recording.

In addition to the suggested mandatory training, other areas to consider are:

  • advocacy;
  • dignity and respect;
  • domestic abuse;
  • mediation;
  • living with risk;
  • people whose behaviour challenges;
  • SARs;
  • self-neglect;
  • complaints;
  • working with carers.

Some organisations may have specific mandatory training.

10. Supervision and Appraisal

Supervision is essential to supporting practitioners, and provides assurance for both the organisation and the practitioner. Workers should feel confident that they are supported to deliver safeguarding and have the right training and professional development through regular supervision and appraisal. Staff should be encouraged to further their knowledge base through gaining additional skills and knowledge. Organisations should ensure that staff receive clinical and/or management supervision that affords them the opportunity to reflect on their practice and the impact of their actions on the adult and others. Supervisors should be qualified to take on these responsibilities.

Appraisals are central to effective practice. Appraisals ensure that all staff are focused on outcomes and have clarity about their role. Staff should expect to receive an annual appraisal, linked to the overall safeguarding strategic plan.

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RELEVANT CHAPTERS

Data Protection Act

South Tyneside Safeguarding Adults Structures and Organisations

1. Introduction

People have a right to know how information will be used and the right to restrict the use of information when exercising choice and control over how they are safeguarded. This may impact on the service that they are offered but it is their right to make an informed choice.

Information governance is subject to a range of legislation, in particular:

Practitioners must be mindful that the information that they collect is lawful and that people are routinely informed about why the information is collected, what will be done with the information and who it is likely to be shared with. Information management requires organisations to have policies and procedures in line with the above. Local authorities and the NHS are required to appoint a Caldicott Guardian to advise and manage its information governance arrangements.

2. Data Protection

See also Data Protection Act chapter

The Data Protection Act 2018 and UK General Data Protection Regulation (UK GDPR) apply to all organisations in the UK that processes personal information. They go hand in hand with the common law duty of confidence and professional and local confidentiality codes of practice to provide individuals with a statutory route to monitor the use of their personal information. In the UK, the Information Commissioner is responsible for the enforcement of data protection legislation and Freedom of Information Act 2000. Advice and guidance on responding to access to files and freedom of information requests can also be found on the Information Commissioner’s website.

The rights of adults and people alleged to have caused harm including providers are upheld under data protection legislation. This means that people have the right:

  • of access to personal information held about them;
  • to prevent processing likely to cause damage or distress;
  • to have inaccurate data about them corrected, blocked or erased;
  • to prevent processing of information about themselves for purposes of direct marketing.

Applying data protection principles to the safeguarding principles means that people should be advised at the earliest opportunity of any safeguarding concerns. Adult Safeguarding: Sharing Information (SCIE) provides guidance for staff on matters of consent and sharing information with family and friends.

3. Professional Accountability

Every time a record is made of a conversation, observation, telephone call, assessment, professionals should quality assure their own work so it measures up to good information governance:

  • contemporaneous;
  • discerns fact from opinion;
  • compliant with legislation;
  • thorough and relevant;
  • contains up to date details.

Professionals should be confident that if the adult using the service /provider were to view the record, it would be:

  1. evidence based;
  2. written in a professional and respectful manner;
  3. compliant with relevant legislation.

The following questions are a guide.

  • What information do staff need to know in order to provide a high quality response?
  • What information is needed to keep adults safe?
  • What information is not necessary?
  • What is the basis for any decision to share (or not) information with a third party?

Care should be taken to avoid personal opinion and comments. There is a risk that that this type of recording is seen at a later date as fact which cannot be evidenced.

Accuracy is essential, not only for effective safeguarding but ensures resources are not wasted. Using abbreviations is unacceptable unless there is an explanation. Copying of medical notes for example ‘R. sided CVA’ can waste time and impact on the ability to protect someone. Noting that the person has had a stroke and finds it difficult to talk on the telephone is relevant and provides information that is easily understood by everyone. A judgement framework needs to consider facts, how different types of evidence can be corroborated and how information can support a reasonable and rational assessment. Checking with the adult for accuracy is good practice.

Assessments are an ongoing process and therefore there is a need to ensure that information is up to date. Ensuring only one record for one person may be part of auditing. Managers might note any concerns where there are duplicate records and implement an immediate action for data cleansing. When working with providers, it should be borne in mind that they are reliant upon reputation for their business. Accurate recording that can be backed up by examples and corroborated supports defensible practice. All records are subject to the retention guidelines set out by the organisation. Through the auditing process records may be disposed of according to each organisation’s policy. Electronic records should be updated and maintained according to the policy.

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1. Step 1: Decision to Initiate Provider Concerns

The decision to initiate a Provider Concerns process may be the outcome of a Quality and Safeguarding meeting, or considered through other means for example, consequence of a Safeguarding Adult Review (SAR) (see Safeguarding Adult Reviews) or a serious concern that meets the agreed provider concerns threshold criteria above.

1.1 Action

The following actions should be taken:

  • conducting immediate checks on the welfare of adults using the service;
  • consult the police about whether there are any possible criminal matters;
  • contact the placing authorities;
  • agree who will chair the process and which will be the lead organisation;
  • convene a Provider Concerns Information meeting;
  • set up meeting with the provider;
  • map out risk and risk management plan;
  • consider commissioning intentions.

1.2 Risk

A risk management plan should be drawn up and updated throughout the process. Where there are high risk concerns, there will be a need to put in place safeguards and agreed triggers to escalate matters. Risk management to be assured that action will be timely and safeguard people on a sustainable basis is essential. Risk will determine commissioning intentions, and be the evidence base upon how decisions are made. Risk management for commissioning authorities may be additional visits both announced and unannounced. Training support for example, an occupational therapist ensuring the right slings are used to reduce immediate risks of falls.

The level of risk should be shared with the provider and frank discussions about any proposed action that might be taken by commissioners, providing adults are not put at further risk by doing so. Providers should be encouraged to find solutions to mitigate against risk. Actions might include providing additional resources to support improvement planning, resourcing training, and purchasing new equipment.

Timescale: Actions to be completed within five working days.

2. Step 2: Initial Provider Information Sharing Meeting

The purpose of the meeting is to:

  • identify and clarify concerns;
  • devise a communication strategy about how adults using the service will be informed and updated;
  • ensure appropriate advocacy and support;
  • listen to the views of the provider;
  • safeguarding planning to consider the type of enquiries, leads and timescales;
  • risk management;
  • consider commissioning intentions;
  • set date for follow up provider meeting.

2.1 Safeguarding planning

Actions need to be able to support a factually based assessment of the validity and likelihood of concerns, their severity and impact and identify any new concerns. Intelligence as far as possible should be triangulated and the source of information identified and based on:

  1. views of adults using the service;
  2. factual information for example staff rotas; and
  3. professional assessment of documentation for example care plans and risk assessments.

Safeguarding planning will address alleged issues with suggested methodology for enabling decision making about whether improvements are needed or not, and who has the appropriate skills to carry out the enquiry.

2.2 Communication strategy

The strategy should address both internal and external communications. A check list for information might include:

  • senior management – need to know;
  • information to the provider and how ongoing communication will be managed;
  • if a suspension on admissions is considered how this is communicated to front line staff and other commissioners and the public;
  • press release;
  • briefing for chief executives and /or elected members;
  • consultation with adults who use services, their families and friends;
  • how information and advice is provided to include adults who fund their own care.

2.3 Meetings with the provider

The chair will inform the provider that it is subject to the Provider Concerns process and share as much information as possible, without compromising any subsequent lines of enquiry. They will be informed of the process and provisional timescales if available. If there is a criminal investigation, the provider will be informed in accordance with Police advice.

2.4 Communication with adults who use services

Adults who use services should be provided with the opportunity of shaping and influencing the quality of services and be kept central to the process. In a residential setting, service users and their families may become anxious about increased activity, seeing more visiting professionals etc, and have the right to be informed, but care should be taken not to raise anxiety. Information sharing should always include adults who use services and their carers so that they are able to make informed choices and retain their independence.

Where there is opportunity for presenting to adults who use the service and carers through a meeting, negotiation with the provider should take place about how this is managed. In those instances where adults receive support at home, as part of the safeguarding plan, care management staff (including Continuing Health Care staff) should make targeted visits to:

  1. ensure that people are safe; and
  2. record their views so that they are considered in the organisational risk management plan.

Adults should be provided with the means of sharing their experiences independently of the provider, and if it is deemed necessary a link worker for adults and their families should be identified and a dedicated phone line available to raise issues in confidence. At the very minimum, checks that the provider has taken action in relation to complaints and acted upon service user surveys should be made.

Timescales: If possible, actions should be agreed in the risk management plan. Where the concern is about a large organisation or particularly complicated, action may take longer. The provider however should be kept informed.

3. Step 3: Provider Meeting

The purpose of the meeting is to:

  • assess and agree the findings from fact finding enquiries;
  • draw up issues for a service improvement plan;
  • update the risk management plan and agree safeguarding measures;
  • consider actions to monitor the safety of people and agree triggers to escalate risk, whilst improvements are being made;
  • consider commissioning intentions (see Appendix 1: Provider Concerns Escalation Process Flowchart);
  • preserve information that may be helpful to police investigations.

Where immediate action is needed this should be taken and not be put on hold until the Findings meeting. The chair should be informed and immediate authorisation for action is made.

3.1 Service improvement plan

This is a high level plan for measuring the effectiveness of interventions to ensure safety, governance, compliance, clinical effectiveness referencing throughout the experience of adults using the service and their informal network. The coordinator should set out the concerns and risks, which should also include any concerns in relation to mental capacity and the Deprivation of Liberty Safeguards. It is important to distinguish between what is safeguarding and what are quality issues that may impact on safeguarding and prioritise high risk areas.

3.2 Meetings with the provider

The chair and lead commissioner (if not the chair) should hold a meeting with the provider as soon after the findings meeting as possible. Leads and timescales will be agreed at the provider meeting. The service improvement plan will be the agreed reference point for assessing and monitoring progress and both the coordinator (who is also the chair) and the provider will retain a copy and update it through a series of monitoring meetings. If there is a contract monitoring officer, commissioner or other relevant member of staff they should be part of these meetings. In the event that the provider advises that they are unable to make the improvements or of possible service failure or interruptions, a further meeting with all stakeholders should be convened to assess risks and impact on service users to determine commissioning based on the risk and safety of adults using the service.

Further meetings to update stakeholders will be made, if and when necessary. Where there is wide reaching, complex concerns and high risk, it is likely that updated meetings are needed more frequently. Where there are serious delays by the provider to implement improvements, a further meeting should always be held to consider the level of risk and appropriate action. Focus should be on risk and the impact on adults using the service. It is important to distinguish between what is safeguarding and what are commissioning responsibilities and if further incidents have occurred. Where there is a high risk and likely need to source alternative provision, commissioners should hold a specific contingency meeting. The chair and the coordinator should be invited.

Timescales for further safeguarding meetings are dependent upon progress of the service improvement plan and the level of risk.

4. Step 4: Quality Assurance

A quality assurance strategy should be agreed that will rigorously test whether improvements have been attained and can be sustained. This may involve a range of staff with the right knowledge, skills and experience to assess the viability of the improvements and might be the same staff involved in fact finding so that they can provide a comparative narrative. Quality assurance activities may include testing an on-call emergency out of hour’s system by calling at the evening and weekend; assessing the impact of training by competency testing staff; making both announced and unannounced visits.

Feedback from adults and carers will act as a control measure to assess whether there has been any noted difference in the service delivery. This may be obtained from holding a follow up meeting with adults in care settings or from a sample of telephone calls to those adults who said that they had experienced a poor service, to see if their view has changed. Support from the local Healthwatch may be appropriate, or other locally managed groups for example Quality Checkers, to add an independent view.

5. Step 5: Closing the Provider Concerns process

Following evidence based improvement, the process will formally come to an end via the provider meeting and the relevant parties including the provider, and the CQC should be notified in writing by the chair. For consideration of a lessons learnt exercise, feedback will be reported to the South Tyneside Safeguarding Children and Adults Partnership together with a summary report detailing the concerns, actions, risk management, outcomes and the effectiveness of safeguarding. Assurances should be made that adults and carers know how to raise any further concerns. It may also be helpful to agree a reviewing and escalation process

Appendix 1: Provider Concern Process Escalation Flowchart

Click here to view Provider Concern Process Flowchart

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RELEVANT CHAPTERS

Working with Providers: Overview

Organisational Abuse Procedures

1. Introduction

Safeguarding concerns can be raised regarding adults within any care setting. Where safeguarding concerns are raised about an individual these should be progressed via a Section 42 Enquiry (see Stage 2: Enquiry) where they meet the criteria as set out in the Care Act, Section 18.

Provider concerns refer to issues that affect a group of people who receive care from a Local Authority commissioned care provider. The outcome of any individual Section 42 Enquiry related to such a care provider should be fed back through this Provider Concerns process. The Provider Concerns process should only be invoked where there are patterns of safeguarding concerns that indicate that the provider has not made any changes to reduce the number of incidents surrounding the same or similar situations and there is concern that the provider is unable to provide care and support in a safe environment that respects the human rights of people in receipt of that care.

2. Organisational Abuse

Organisational abuse (or organisational safeguarding) is a broad concept and is not just applicable to high profile cases, for example Winterbourne View. It is an umbrella term defined as, ‘the mistreatment or abuse or neglect of an adult at risk by a regime or individual’s within settings and services that adults at risk live in or use, that violate the person’s dignity, resulting in lack of respect for their human rights.’

Organisational abuse occurs when the routines, systems and regimes of an institution result in poor or inadequate standards of care and poor practice which affects the whole setting and denies, restricts or curtails the dignity, privacy, choice, independence or fulfilment of adults. Organisational abuse can occur in any setting providing health and social care. A number of inquiries into care in residential settings have highlighted that organisational abuse is most likely to occur when staff:

  • receive little support from management;
  • are inadequately trained;
  • are poorly supervised and poorly supported in their work; and
  • receive inadequate guidance.

3. Early Identification

Hull University (Abuse in Care Project, 2012) identified over 90 individual indicators or warning signs for concern. A summary of factors which can increase the likelihood of abuse occurring within provider settings are drawn from these indicators:

  • management and leadership;
  • staff skills, knowledge and practice;
  • residents’ behaviours and wellbeing;
  • the service resisting the involvement of external people and isolating individuals;
  • the way services are planned and delivered;
  • the quality of basic care and the environment.

Where there is proof or suspicion of organisational abuse by omission, for example the abuse and neglect highlighted in the Winterbourne View and the Old Deanery reports, or omission to provide care and support that puts adults at risk of or experiencing abuse or neglect, action will be channelled through this Provider Concerns process.

4. Principles

The following principles apply to the Provider Concerns process:

  • the safety and wellbeing of adults using the service is paramount;
  • strong partnerships that acknowledge the expertise of others;
  • openness and transparency to achieve positive outcomes;
  • joint accountability for risk between commissioners, safeguarding leads, providers, the police, the local authority, the ICB and other stakeholders who may be involved;
  • prudent targeted use of resources;
  • information is shared responsibly between all agencies, including the provider;
  • cooperation between agencies;
  • natural justice.

How concerns are addressed depends on level of risk and the impact on people using the service. There are no hard and fast rules, and each case should be considered on its own merit. The process can challenge capacity of one service /organisation therefore it is important that there is a shared approach, breaking down barriers between services and organisations to provide a joined up, one team approach.

5. What is a Provider Concern?

The provider concerns process can relate to both contracted providers and non-commissioned providers. We have to acknowledge the difference between individual safeguarding concerns, assessment and investigations within a provider setting to that of concerns impacting on a larger group of individuals within that setting.

Additionally we must recognise the difference between issues that would be dealt with through normal contract management processes and what should be escalated under the Provider Concern Process and could ultimately constitute organisational abuse.

6. The Provider Concerns Process

The South Tyneside Safeguarding Children and Adults Partnership sets out a range of circumstances as to when the process should apply.  Provided below are some working examples:

  • a number of safeguarding concerns raised for similar issues, within a few months of each other in respect of individuals who are receiving care from the same provider;
  • a combined number of safeguarding concerns across a set of group homes owned by the same organisation;
  • inappropriate recruitment processes or staffing levels;
  • lack of, or unsuitable care plans.

In order to clarify these matters further we need to consider and establish what the working threshold level is for applying the provider concerns process. This is best achieved through the assessment of risk and is something which we will look at in more detail in the sections to follow.

6.1 Provider Concerns Threshold Level

At times it is difficult to decide whether or not a provider should go into provider concerns. Consideration should be given to the associated risk. Appendix 1, Provider Concern Process Flowchart and Appendix 2, Provider Concerns Threshold Table provide a summary and demonstrate combined threshold levels, as an indication as to how concerns should be managed.

It is important to view each situation on a case by case basis, collating inter-agency intelligence and utilising specific risk assessment processes. Risk can and should be considered at various stages of the process.  The risk assessment tool can be used to compile information to help decide whether a provider should go into serious concerns or it can be use throughout the process to monitor and mitigate risk. The risk assessment will cover safeguarding considerations and compliance information; it will also include a specific risk analysis of the provider and the current situation.

It is best to collate multi-agency information and gain an agreement as to the risks involved and whether to take the matter forward through the provider concerns process. It may be beneficial to use this to evidence the level of concern prior to initial decision making. It must be acknowledged that the collection of information must not delay initial conversations.

Where concerns are growing but not yet serious and time allows the provider intelligence meeting can be used, alternatively a decision from a responsible officer is required. If at this point the responsible officer feels matters are still unclear then the case should go into provider concerns and the decision taken at the initial meeting.

7. Roles and Responsibilities

7.1 Host authority

The local authority in the area where abuse or neglect has occurred is the host authority.

The host authority is responsible for:

  • liaising with the regulator if any concerns are identified about a registered provider;
  • determining if any other authorities are making placements, alerting them and liaising with them over the issues in question / under investigation;
  • coordinating action under safeguarding and has the overall responsibility to ensure that appropriate action is taken and monitoring the quality of the service provided;
  • ensuring that advocacy arrangements are in place where needed, and care management responsibilities are clearly defined and agreed with placing authorities;
  • ensuring that there is a chair and administration of meetings, and provides a clear audit trail of agreements, responsible leads for particular actions and timescales;
  • taking on the lead commissioner role in relation to monitoring the quality of the service provision.

7.2 Placing authority

The local authority that has commissioned the service for an individual/s delivered by a provider where there is a provider concern.

The placing authority is responsible for:

  • duty of care to people it has placed that their needs continue to be met;
  • contribute to safeguarding activities as requested by the host authority, and maintain overall responsibility for the individual they have placed;
  • ensure that the provider, in service specifications, has arrangements in place for safeguarding;
  • the placement continues to meet the individual’s needs;
  • undertaking specific mental capacity assessments, or best interest decisions for, individuals they have placed;
  • reviewing the contract specification, monitoring the service provided and negotiating changes to the care plan in a robust and timely way;
  • all usual care management responsibilities;
  • assessments under the Deprivation of Liberty Safeguards;
  • keeping the host authority informed of any changes in individual needs and/or service provision.

7.3 Care Quality Commission

The Care Quality Commission (CQC)  acts independently. It is a valued partner in the process of information sharing and working to tackle areas of concern. Its expertise in working with providers and standard setting may support safeguarding processes. The CQC has the authority to take appropriate enforcement action where providers are found to be slipping, but have not yet breached the requirement. This supports the CQC’s approach to inspection and enforcement which is based less around compliance of set outcomes, and instead focuses on five key questions about care, the Fundamental Standards:

  • Is it safe?
  • Is it effective?
  • Is it responsive?
  • Is it caring?
  • Is it well led?

Where there has been a recent inspection it may be helpful for providers to share pre-publicised reports, to support the principle of openness and transparency. In some instances providers may be addressing issues identified by inspections and adult safeguarding and it makes sense to address both through agreed joint processes.

7.4 Local authority

In most cases, the local authority will lead on safeguarding action in consultation with partners and in particular regulators. The principle on who is best to lead on an enquiry should always be determined by the issue, who the lead commissioner is and the knowledge and expertise required.

7.5 North East and North Cumbria Integrated Care Board

The Integrated Care Board (ICB) should be informed where there are a number of individual safeguarding concerns regarding people within a health commissioned service.  The ICB will progress these concerns through the Quality Review process.

7.6 Police

As with all criminal matters the police are the leads and must be consulted about any additional proposed action.

7.7 Frontline workers

Throughout the safeguarding processes a number of tasks and actions will be identified. The table below contains suggested roles, although action should always be determined on a case by case basis and the best qualified person to assess or assure the issue assigned. A system whereby professional knowledge and skills complement each other is the most effective way to safeguard people.

Agency / individual Tasks
Social workers / managers

Care managers

Reviewing officers

Contract monitoring officers

Commissioners

 Review care plans and risk assessments

Analyse staff rotas

Check incident / accident reports

Review policy and procedures

 

Mental capacity and DoLS audits
Nurses

Occupational therapists

Physiotherapists

Behavioural therapists

Pharmacists

 Infection control

Review nursing and treatment plans

Manual handling assessments

Safety and use of equipment e.g. hoists

Falls policies and strategies to reduce falls

Medicine management
General Practitioners Primary health care

Raising safeguarding concerns
Northumbria Police Service, Community Safety Unit Criminal investigations

Wilful neglect

Provide expertise on investigative practice

Crime prevention visits
Legal services Advice where there are legal challenges to safeguarding or contractual matters

Advice on decommissioning decisions
Adults who use services Raising concerns and complaints

Monitoring improvements
Advocates

Family / friends / visitors

 Supported decision making

Consulted on best interest decisions

Raising concerns, monitoring improvements

8. Defining Roles, Responsibilities and Process

Various numbers of professionals and agencies may be involved with individuals and their care provider, all in a position to identify potential serious concerns. We will look at the key groups of professionals involved at a local level, how they interact with the process and consider how they operate to safeguard individuals, improve the quality of service delivery provided in our Borough and identify potential serious concerns.

Practitioners from all social work teams are in a key position to monitor the care environment across all types of contracted provision, assess the quality and delivery of provider care plans, provide early notification to quality and commissioning officers in relation to compliance and quality  issues or report safeguarding concerns.

Practitioners (from all teams) are responsible for ensuring that provider care plans and the actual delivery of care addresses the needs established during the assessment and are in accordance with the social care/health support plan.  Re-assessments must be conducted jointly with the care provider and changes to provision must be reflected in both the revised social care support plan and the provider care plan.

Where care planning and delivery is failing practitioners should raise the issues with the care provider.  Practitioners are responsible for reporting any identified safeguarding issues and engaging appropriately with the ongoing process. Where issues are related to contract compliance or quality concerns the practitioner must inform the commissioning team as appropriate and work with them accordingly.

Line managers and / or Assistant Team Managers must be informed of arising issues. In turn they make the initial decision as to whether these issues should be shared through the multi-agency monthly provider intelligence meeting, or should be progressed immediately to the Provider Concern Process.

The Let’s Talk Team (see Local Contacts) manage all safeguarding concerns and capture the information presented through the initial contact. This in turn is forwarded on to the relevant Adult Social Care Manager who is responsible for investigating concerns raised in relation to adults at risk. Within the first 24 hours, the duty manager evaluates the situation and decides whether to progress through the recognised safeguarding processes. Any safeguarding alerts that include a provider as an alleged perpetrator will be progressed via the Safeguarding Team.

The Let’s Talk Team play a crucial role in collating and interpreting information from various sources to build up a picture of what is happening across our contracted care providers. Working in conjunction with key partners they take a preventative approach, working to support and educate providers thus stopping issues escalating into what would be considered as serious provider concerns. Where the threshold for provider concerns has been reached the safeguarding team form a part of the multi-agency response.

9. Adults who use Services / Carers / Advocates

As with Section 42 enquiries it is essential that adults using the service are spoken to, and encouraged and supported to:

  • tell us what outcomes they want
  • raise complaints and concerns;
  • questioning when care is not provided according to care plans;
  • care is not delivered when expected; or
  • care is not provided with dignity and respect.

Where there are patterns of complaints and concerns these may indicate poor quality service or a safeguarding concern.

10. Differentiating between Poor Care and Potential Safeguarding Issues

10.1 Poor care

Poor care, includes instances of:

  • a one-off medication error (although this could have had very serious consequences);
  • an incident of under-staffing, resulting in a person’s incontinence pad being unchanged all day;
  • poor quality, unappetising food;
  • one missed visit by a care worker from a home care agency.

10.2 Potential causes for concern

Potential causes for concern, include instances of:

  • a series of medication errors;
  • an increase in the number of visits to A&E, especially if the same injuries happen more than once;
  • changes in the behaviour and demeanour of adults with care and support needs;
  • nutritionally inadequate food;
  • signs of neglect such as clothes being dirty;
  • repeated missed visits by a home care agency;
  • an increase in the number of complaints received about the service;
  • an increase in the use of agency or bank staff;
  • a pattern of missed GP or dental appointments;
  • an unusually high or unusually low number of safeguarding alerts.

There should be careful analysis to understand what is intentional and unintentional harm. However, where there is unintentional harm due to lack of guidance for staff this may also constitute organisational abuse.

 Appendix 1: Provider Concerns Process Flowchart

Click here to view Provider Concern Process Flowchart

Appendix 2: Provider Concerns Threshold Table

Click here to view Provider Concerns Process

Appendix 3: Provider Intelligence Meeting (Domiciliary Care and Care Homes)

Sharing information on quality and safeguarding, strengthening the relationship and knowledge sources from commissioning, safeguarding, CQC, ICB and front line practitioners assists in driving up standards. Formal mechanisms for sharing information between agencies are helpful to determine risk levels and the most proportionate response. The purpose of such mechanisms is to ensure both soft and hard intelligence, available agencies is brought together in an effective and cohesive manner to facilitate timely action.

South Tyneside local authority has implemented a formal intelligence meeting, with key partners from the CQC and the ICB. The ‘Provider Intelligence Meeting’ has the ability to:

  • reduce the need for safeguarding under Provider Concerns procedures;
  • enhance the standards of care and support by sharing early warning signs with providers;
  • target resources effectively to reduce duplication;
  • support prevention strategies;
  • support continuous service improvements.

3.1 Liaising and reporting to the police 

Information arising from these meetings should always be provided to the police where there is an indication of possible crime. It may also be prudent to have police presence at such meetings, so that they can make an early assessment. Local protocols will determine how information is shared with the police.

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RELEVANT CHAPTER

Stage 3: Plan / Review

Making Safeguarding Personal

1. Introduction

Safeguarding can be closed at any stage where:

  • the local authority has completed its statutory duty in respect of the adult;
  • it is agreed by all involved that an enquiry is no longer needed; or
  • the enquiry has been completed, and the risk assessment, safeguarding plan and personal outcomes have been reviewed.

Closures at any stage of the safeguarding process should be subject to an evaluation of outcomes by the adult or their advocate. If they do not agree with the decision to close the enquiry, their reasons should be fully explored and documented, alternatives discussed and a satisfactory resolution achieved.

The local authority’s duty under the Care Act 2014, continues until all necessary actions have been taken to safeguard the adult and there is an active plan in place to maintain their safety. The safeguarding response under the procedures must be formally closed by a team manager / senior social worker in the local authority.

2. Actions Prior to Closure

The practitioner who has been the lead coordinator for the enquiry should ensure all relevant people are advised in writing that the enquiry is being closed, and that they all know who to contact if they have any further concerns. Before the enquiry is closed, the lead practitioner should ensure:

  • the adult, or their advocate, states their outcomes identified at the start of the enquiry have been achieved;
  • the adult and their carer know who to contact if they have any concerns about abuse or neglect in the future;
  • all actions have been completed or are ongoing;
  • a current risk assessment and management plan is in place;
  • a safeguarding plan is in place where required;
  • all necessary records have been completed and case records contain all relevant information and completed forms;
  • all the stakeholders have been informed of the enquiry’s outcome, receive an update of the completed action plan and any ongoing risk management / safety plan.

Following the safeguarding enquiry closure, where reviews such as care management assessments, Care Programme Approach (CPA), care and support plans, health or placements are planned, checks should be carried out as to whether there has been any reoccurrence of the abuse or neglect, or new concerns have been raised.

Individuals should be advised on how and who to contact with agreement on how matters will be followed up with the adult if there are further concerns. It is good practice where a care management assessment, Care Programme Approach (CPA), reassessment of care and support, health review, placement review or any other pre-booked review is due to take place following the safeguarding enquiry, for a standard check to be made that there has been no reoccurrence of concerns.

Closure records should note the reason for this decision as well as the views of the adult to the proposed closure. The relevant team manager responsible should ensure that all actions have been taken, building in any personalised actions:

  • agreements with the adult to closure;
  • referral for assessment and support;
  • advice and information provided;
  • all organisations involved in the enquiry updated and informed;
  • feedback has been provided to the referrer;
  • action taken with the person alleged to have caused harm;
  • action taken to support other service users;
  • referral to children and young people’ services made (if necessary);
  • outcomes noted and evaluated by the adult;
  • consideration for a SAR;
  • any lessons to be learnt.

3. Closure Records

Closure records should note the reason for the decision and the views of the adult to the proposed closure. They should also include:

  • the adult’s outcomes, including their evaluation of what has been achieved;
  • any referrals made for assessment;
  • any referrals for care and support services;
  • any advice and information provided;
  • which practitioners, including their organisation, have been updated and informed;
  • feedback has been provided to the initial referrer;
  • details of any action taken with the person alleged to have caused harm, and any related ongoing processes including contact details of practitioners involved;
  • details of any action taken to safeguard any other adults who may have been at risk of abuse or neglect by the same alleged perpetrator, or impacted by what occurred;
  • details of any referrals made in relation to children and young people involved in the case;
  • whether there has been any consideration for a safeguarding adults review, and if so the outcome of the decision;
  • any lessons to be learnt and how these will be disseminated;
  • completion of the safeguarding data returns (see Safeguarding Adults Data chapter).

The responsible manager should ensure that all actions have been taken, before signing off the closure.

Whilst the safeguarding enquiry may have been closed, other processes may continue for example, professional body investigations, safeguarding adult review or criminal proceedings. These may take time to conclude. In such circumstances consideration should be given to any impact of these processes on the adult and their family, and responsibility for monitoring such effects and also communicating progress in relation to the enquiries should be agreed. Where there are ongoing criminal investigations or court trials, the safeguarding enquiry can be closed providing the adult is safeguarded, as outlined above.

4. Closing Enquiries when other Processes Continue

The adult safeguarding process may be closed but other processes may continue, for example, a disciplinary or professional body investigation. These processes may take some time. Consideration may need to be given to the impact of these on the adult and how this will be monitored. Where there are outstanding criminal investigations and pending court actions, the adult safeguarding process can also be closed providing that the adult is safeguarded. All closures, no matter at what stage, are subject to an evaluation of outcomes by the adult. If the adult disagrees with the decision to close the safeguarding process, their reasons should be fully explored and alternatives offered.

At the close of each enquiry there should be evidence of:

  • enhanced safeguarding practice ensuring that people have an opportunity to discuss the outcomes they want at the start of safeguarding activity;
  • follow-up discussions with people at the end of safeguarding activity to see to what extent their desired outcomes have been met;
  • recording the results in a way that can be used to inform practice and provide aggregated outcomes information for the South Tyneside Safeguarding Adults Board
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RELEVANT CHAPTERS

Stage 2: Enquiry

Stage 4: Close Process

Making Safeguarding Personal

1.Introduction

In most cases there will be a natural transition between deciding what actions are needed and the end of the enquiry, into formalising what these actions are and who needs to be responsible for each action. This is the adult safeguarding plan. A safeguarding plan for an adult is not a care and support plan. It will focus on care provision only in relation to the aspects that safeguard against abuse or neglect, or which offer a therapeutic or recovery based resolution. In many cases the provision of care and support may be important in addressing the risk of abuse or neglect, but where this is the intention the safeguarding plan must be specific as to how this intervention will achieve this outcome. The person may, therefore, have a care and support plan and a safeguarding plan.

2. The Safeguarding Plan

The safeguarding plan should set out:

  • who is the lead – where possible this should be the same person who completed the enquiry;
  • what steps are to be taken to assure the future safety of the adult;
  • how each organisation /practitioner will contribute to the plan;
  • the person’s aims hope and wishes;
  • any adults / carers who are important in protecting the person;
  • contingency plans should the safeguarding plan not achieve its objectives or if the risks to the adult change;
  • any new services / changes to existing services;
  • the provision of any support, treatment or therapy, including ongoing advocacy;
  • any modifications needed in the way services are provided (for example, same gender care or placement or appointment of an Office of the Public Guardian (OPG) deputy);
  • how best to support the adult through any action they may want to take to seek justice or redress;
  • any ongoing risk management strategy as appropriate;
  • arrangements for reviewing the plan if circumstances change or where there is a request to do so from the adult, carer or any involved practitioner.

The safeguarding plan should outline the roles and responsibilities of all individuals and agencies involved, and should identify the Safeguarding Adults Manager who will monitor and review the plan, and when this will happen. Safeguarding plans should be person centred,  outcome focused and made with the full participation of the adult. In some circumstances, it may be appropriate for safeguarding plans to be monitored through ongoing care management responsibilities. In other situations, a specific safeguarding review may be required.

The plan should be updated throughout the enquiry. Timescales for achievements and review should be built into the plan.

It should be recorded and available in a format that is accessible to the adult concerned. It should also be documented in the adult’s case records, as should each change.

It should be agreed who the plan can be shared with and under what circumstances and this should be recorded in the case record.

3. Review of the Enquiry

A review of the enquiry may be optional. The identified Safeguarding Adults Manager lead should monitor the plan on an ongoing basis, within agreed timescales. The purpose of the review is to:

  • evaluate the effectiveness of the safeguarding plan;
  • evaluate whether the plan is meeting / achieving outcomes;
  • evaluate risk.

Reviews of safeguarding plans, and decisions about plans should be communicated and agreed with the adult. Following the review process, it may be determined that:

  • the safeguarding plan is no longer required; or
  • the safeguarding plan needs to continue.

Any changes or revisions to the plan should be made, new review timescales set (if needed) and agreement reached regarding the lead professional, who will continue monitoring and reviewing it. It may also be agreed, if needed, to instigate a new adult safeguarding enquiry (Section 42). New safeguarding enquiries will only be needed when the local authority determines it is necessary. If the decision is that further enquiries would be a disproportionate response to new or changed risks, further review and monitoring may continue.

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RELEVANT CHAPTERS

Stage 1: Concerns

Stage 3: Plan / Review

Making Safeguarding Personal

RELEVANT INFORMATION

What Constitutes a Safeguarding Concern and how to Carry out an Enquiry (LGA)

 

A diagram showing the steps taken when a safeguarding adults concern is raised.

1. Introduction

When a safeguarding adult concern is shared with the South Tyneside Let’s Talk Team, it must make or arrange an enquiry as required under Section 42 of the Care Act 2014;

‘The Local Authority must make (or cause to be made) whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult’s case (whether under this Part or otherwise) and, if so, what and by whom.’

The enquiry should establish whether and what action needs to be taken to prevent or stop abuse or neglect. The local authority should aim to provide swift and personalised safeguarding responses, involving the adult in the decision making process as far as possible. For further guidance about cases in which the adult may lack capacity or has a substantial difficulty in being involved, see Mental Capacity chapter. The local authority should record the information received, the views and wishes ascertained, the decisions taken and the reasons for them and any advice and information given.

2. Role of the Local Authority

The Care Act 2014 sets out the local authority’s responsibility for adult safeguarding: responsibility to ensure enquiries into cases of abuse and neglect. Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult is at risk of, being abused or neglected.

There are a number of steps that should be taken when responding to safeguarding concerns in individual cases including:

  • information gathering;
  • decision making;
  • carrying out an enquiry;
  • taking action / developing a safeguarding plan.

The local authority should decide very early on in the process who is the best person / organisation to lead on the enquiry. The local authority retains the responsibility for ensuring that the enquiry is referred to the right place and is acted upon. If the local authority has asked someone else to make enquiries, it is able to challenge the organisation / individual making the enquiry if it considers that the process and / or outcome is unsatisfactory. In exceptional cases, the local authority may undertake an additional enquiry, for example, if the original fails to address significant issues.

The information in some referrals may be sufficiently comprehensive that it is clear that immediate risks are being managed, and that the criteria are met for a formal Section 42 enquiry. In other cases some additional information gathering may be needed to fully establish that the three steps are met. Decisions need to take into account all relevant information through a multi-agency approach wherever possible, including the views of the adult taking into consideration mental capacity and consent (see the chapters on Mental Capacity and Consent in Relation to Safeguarding).

The degree of involvement of the local authority will vary from case to case, but as a minimum must involve decision making about how the enquiry will be carried out, oversight of the enquiry, decision making at the conclusion of the enquiry about what actions are required, ensuring data collection is carried out, and quality assurance of the enquiry has been undertaken. This decision on how the enquiry is progressed is made by the relevant team manager.

3. Purpose of the Enquiry

The purpose of the enquiry is to decide whether or not the local authority (or another organisation, or person), should act in order to help and protect the adult.

If the local authority decides that another organisation should make the enquiry, for example a care provider, the local authority should be clear about timescales, the need to know the outcomes of the enquiry and what action will follow if this is not done.

4. Criminal Investigations

Although the local authority has the lead role in making enquiries or requesting others to do so, where criminal activity is suspected, early involvement of the police is essential. Police investigations should be coordinated with the local authority who may support other actions, but should always be police led.

4.1 Ill treatment and wilful neglect

See also Ill Treatment and Wilful Neglect chapter

Ill treatment covers both deliberate acts of ill treatment and also those which are reckless and  result in ill treatment

Wilful neglect usually means that a person has deliberately failed to carry out an act that they knew they had a duty to perform; such acts would be a serious departure from required standards of treatment.

The police will determine whether there should be criminal investigations against people in positions of trust where there is ill treatment and wilful neglect. The Mental Capacity Act 2005 makes it a specific criminal offence to wilfully ill treat or neglect a person who lacks mental capacity.

The Mental Health Act 1983  creates an offence in relation to staff employed in hospitals or mental health nursing homes where there is ill treatment or wilful neglect. The Criminal Justice and Courts Act 2015 relates to offences by care workers and care providers who mistreat persons with capacity in a health or social care setting.

See also Section 42 Enquiry Flowchart.

5. Conversations with the Adult (including Appropriate Support)

See also Making Safeguarding Personal chapter

Professionals and other staff need to handle safeguarding enquiries in a sensitive and skilled manner to ensure that any potential distress to the adult is minimised.

In the majority of cases, unless it is unsafe to do so, each enquiry will start with a conversation with the adult. The relevant team manager should ensure if conversations have already taken place and are sufficient. The adult and / or their advocate should not have to repeat their story. In many cases staff / organisation who already know the adult well may be best placed to lead on the enquiry. They may be a housing worker, a GP or other health worker such as a community nurse or a social worker. While many enquiries will require significant input from a social care practitioner, there will be aspects that should and can be undertaken by other professionals.

Points to consider include:

  • the pace of conversations;
  • whether the presenting issue identifies the risk to the adult’s safety, or whether there are additional risks to be considered;
  • the involvement of an independent advocate is the person has no one to represent them and they have substantial difficulty being involved in the conversation (see Independent Advocacy chapter);
  • wider understanding and assessment of the adult’s overall wellbeing;
  • The adult should be aware at the end of the meeting, what action will be taken and provided with contact details for key people.

Objectives of the meeting should include:

  • establishing the facts;
  • ascertain the adult’s views and wishes and preferred outcomes;
  • assess the needs of the adult for protection, support and redress and how these might be met;
  • protect the person from the abuse and neglect, in accordance with the wishes of the adult where possible;
  • enable the adult to achieve resolution where possible.

Staff need to handle enquiries in a sensitive and skilled way to ensure minimal distress to the adult and where information is already known people should not have to tell their story again. This does not prevent clarification being sought where necessary. There is a skill involved in eliciting information and asking the right questions, to ascertain what the concern is, how it impacts on the adult, what action they would find acceptable and the level of associated risk. Whilst it is essential to put the adult at ease, and to build up a rapport, the objectives of an enquiry should focus the conversation.

6. Safeguarding and Mental Capacity

See also Mental Capacity chapter.

Safeguarding enquiries can potentially involve decision making at a number of different stages of the process. Mental capacity must be assessed when decisions are being made or action taken on behalf of an adult.

An assessment of mental capacity should be considered in all safeguarding cases where:

  • the adult has a formal diagnosis of cognitive impairment;
  • a neuro-psychological assessment testing suggests they are cognitively impaired;
  • there are concerns about their capacity, which have been raised by others;
  • there are discrepancies in their own evaluation of their abilities;
  • there is evidence to suggest they may be undergoing a change in personality;
  • they fail to learn from their mistakes;
  • they repeatedly make risky or unwise decisions.

For information about the test for mental capacity see Section 4, Determining Capacity, Mental Capacity chaprer.

7. Information Gathering

7.1 Who to consult

The following is a diagram of who should be consulted when a safeguarding referral has been received (taken from Chapter 14, Care and Support Statutory Guidance). This should also include the adult’s carer and / or family, where appropriate and where it would not put the adult at any further risk or abuse or neglect.

 

Following information gathering and consultation, if the issue cannot be resolved or the adult remains at risk of abuse or neglect (actual or suspected), the local authority’s duty to enquire (under section 42) continues until it decides what action is necessary to protect the adult and by whom and it can ensure that this action has been taken.

8. Principles for Local Decision Making Process

The following principles should be applied during the decision making process:

  • empowerment: presumption of person led decisions and informed consent;
  • prevention: it is better to take action before harm occurs;
  • proportionate and least intrusive response appropriate to the risk presented;
  • protection: support and representation for those in greatest need;
  • partnership: local solutions through services working with their communities;
  • communities: have a part to play in preventing, detecting and reporting neglect and abuse;
  • accountability and transparency in delivering safeguarding;
  • feeding back whenever possible.

9. Desired Outcomes identified by the Adult

The desired outcome by the adult should be clarified and confirmed at the end of the conversation/s, to:

  • ensure that the outcome is achievable;
  • manage any expectations that the adult may have and;
  • give focus to the enquiry;
  • promote their wellbeing.

Staff should support adults to think in terms of realistic outcomes, but should not restrict or unduly influence the outcome that the adult would like. Outcomes should make a difference to risk, and at the same time satisfy the person’s desire for justice and enhance their wellbeing.

The adult’s views, wishes and desired outcomes may change throughout the course of the enquiry process. There should be an ongoing dialogue and conversation with the adult to ensure their views and wishes are gained as the process continues, and enquiries re-planned should the adult change their views.

Talking through an enquiry may result in resolving it. If not, the duties under Section 42 continue. If the adult has mental capacity and expresses a clear and informed wish not to pursue the matter further, the local authority should consider whether it is appropriate to end the enquiry. It should consider whether it still has reasonable cause to suspect that the adult is at risk and whether further enquiries are necessary before deciding whether further action should be taken. The adult’s consent is not required to take further steps, where appropriate, but the local authority must bear in mind the importance of respecting the adult’s own views. This decision will be made by the local authority relevant team manager by checking with the adult and consulting with relevant partners and advocate.

10. Planning an Enquiry under further Section 42 Duties

All enquiries need to be planned and coordinated and key people identified. No agency should undertake an enquiry prior to a planning discussion, unless it is necessary for the protection of the adult or others. Enquiries should be proportionate to the particular situation. The circumstances of each individual case determine the scope and who leads it. Enquiries should be outcome focussed, and best suit the particular circumstances to achieve the outcomes for the adult. There is a statutory duty of cooperation and in most cases there will be an expectation that enquiry will be made as requested. The statutory duty does not apply if cooperation would be incompatible with its own duties, or would have an adverse effect on its own functions.

When planning an enquiry, a review should be undertaken of:

  • the adult’s mental capacity to understand the type of enquiry, the outcomes and the effect on their safety now and in the future;
  • whether consent has been sought;
  • whether an advocate or other support is needed;
  • the level and impact of risk of abuse and neglect;
  • the adult’s desired outcome;
  • the adult’s own strengths and support networks.

11. Communication and Actions

It may be helpful to agree the best way to keep the adult and relevant parties informed. Where the enquiry is complicated and requires a number of actions that may be taken by others to support the outcome. It may be appropriate for a round table multi-agency complex panel meeting. Where enquiries are simple single agency enquiries, it may not be necessary to hold a meeting. Action should never be put on hold, due to the logistics of arranging meetings. Proportionality should be the guiding principle. If the adult wishes to participate in meetings with relevant partners, one should be convened. Action however, should not be ‘on hold’ until a meeting can be convened. If the adult does not have the capacity to attend, then an advocate should represent their views.

Good Practice Guide: Involving Adults in Safeguarding Meetings
Effective involvement of adults and / or their representatives in safeguarding meetings requires professionals to be creative and to think in a person centred way:

  • How should the adult be involved?
  • Where is the best place to hold the meeting?
  • How long should the meeting last?
  • Timing of the meeting?
  • Agenda
  • Preparation with the adult
  • Who should chair?
  • Agreement by all parties to equality

Information sharing should be timely, cooperation between organisations to achieve outcomes is essential and action coordinated keeping the safety of the adult as paramount. Information sharing should comply with all legislative requirements.

Where one agency is unable to progress matters further, for example a criminal investigation may be completed but not necessarily achieve desired outcomes (e.g. criminal conviction), the local authority in consultation with the adult and others decide if and what further action is needed.

12. Support Networks

The strengths of the adult should always be considered. Mapping out with the adult and identifying their strengths and that of their personal network, may reduce risks sufficiently so that people feel safe without the need to take matters further.

Risk should be assessed and managed at the beginning of the enquiry and reviewed throughout. A multi-agency approach to risk should aim to:

  • prevent further abuse or neglect;
  • keep the risk of abuse or neglect at a level that is acceptable to the person and;
  • support the individual to continue in the risky situation if that is their choice and they have the capacity to make that decision.

13. Types of Safeguarding Enquiries

Good Practice Guidance
Types of Enquiries  Who might lead
Criminal (including assault, theft, fraud, hate crime, domestic abuse and abuse or wilful neglect. Police
Domestic abuse (serious risk of harm) Police coordinate the MARAC process
Anti-social behaviour (e.g. harassment, nuisance by neighbours) Community safety services/ local policing (for example Neighbourhood Police Teams
Breach of tenancy agreement (e.g. harassment, nuisance by neighbours) Landlord / registered social landlord / housing trust / community safety services
Bogus callers or rogue traders Trading Standards / police
Complaint regarding failure of service provision (including neglect of provision of care and failure to protect one service user from the actions of another) Manager / proprietor of service / complaints department / Ombudsman (if unresolved through complaints procedure)
Breach of contract to provide care and support Service commissioner (for example local authority, NHS, ICB)
Fitness of registered service provider CQC
Serious Incident (SI) in NHS settings Root cause analysis investigation by relevant NHS Provider
Unresolved serious complaint in health care setting CQC, Health Service, Ombudsman
Breach of rights of person detained under the MCA 2005 Deprivation of Liberty Safeguards 2009 (DoLs) CQC, local authority, OPG / Court of Protection
Breach of terms of employment/disciplinary procedures Employer
Breach of professional code of conduct Professional regulatory body
Breach of health and safety legislation and regulations HSE / CQC /local authority
Misuse of enduring or lasting power of attorney or misconduct of a court-appointed deputy OPG / Court of Protection / police
Inappropriate person making decisions about the care and wellbeing of an adult who does not have mental capacity to make decisions about their safety and which are not in their best interests OPG / Court of Protection
Misuse of Appointeeship or agency DWP
Safeguarding Adults Review SAB

See Making Safeguarding Personal (Local Government Association) for a range of information.

Enquiries can range from non-complex single agency interventions to multi-agency complex enquiries. The key questions in choosing the right type of enquiry, is dependent on:

  • what outcome does the adult want?
  • how can enquiries be assessed as successful in achieving outcomes?
  • what prevention measures need to be in place?
  • how can risk be reduced?

Identifying the primary source of risk may assist in deciding what the most appropriate and proportionate response to the individual enquiry might be. There are no hard and fast rules and judgement will need to be made about what type of enquiry and actions are right for each particular situation.

13.1 Linking different types of enquiries

There are a number of different types of enquiries. It is important to ensure that where there is more than one enquiry that information is dovetailed to avoid delays, interviewing staff more than once, making people repeat their story. Other processes, including police investigations, can continue alongside the safeguarding adult’s enquiry. Where there are an organisation’s human resources processes to consider, it is important to ensure an open and transparent approach with staff, and that they are provided with the appropriate support, including trade union representation. The remit and authority of organisations need to be clear when considering how different types of investigations might support Section 42 enquiries.

14. Enquiry Reports

Once all actions have been completed a report should be collated and drawn up by the enquiry lead, in consultation with the relevant team manager. In some more complex enquiries, there may be a number of actions taken by other staff that supports the enquiry. Where there are contributions from other agencies / staff, these should be forwarded within agreed formats and time frames, so that there is one comprehensive report that includes all sources of information.

Reports need to be concise, factual and accurate. Reports should be drafted and discussed with the adult / advocate. Reports need to address general and specific personalised issues. They should cover:

  • views of the adult;
  • whether outcomes were achieved;
  • is there evidence that Section 42 criteria were met;
  • whether any further action is required, and if so by whom;
  • who supported the adult and if this is an ongoing requirement.

In some enquiries, there will be an investigation, for example a disciplinary investigation; these might be appended to the enquiry report. In drawing up the report, the risk assessment should be reviewed and any safeguarding plan adjusted accordingly. Recommendations should be monitored and taken forward. Agencies are responsible for carrying out the recommendations which might be included in future safeguarding plans.

15. Standards and Analysis

Reports should be reviewed against required standards and analysed to assess whether there are gaps, contradictions and that information has been triangulated, i.e. is the report evidence based, and is there sufficient corroboration to draw conclusions. The report and recommendations of the enquiry should be discussed with the adult and or their advocate, who may have a view about whether it has been completed to a satisfactory standard.

Overall the relevant team manager will decide if the enquiry is completed to a satisfactory standard. If another organisation has led on the enquiry, the local authority may decide that a further enquiry should be undertaken by the local authority. The exception to this is where there is a criminal investigation and in this case, the local authority should consider if any other enquiry is needed that will not compromise action taken by the police.

16. Outcome to the Enquiry

All enquiries should have established outcomes that determine the effectiveness of interventions. Decisions should be made whether:

  • the adult has needs for care and support;
  • they were experiencing or at risk of abuse or neglect;
  • they were unable to protect themselves;
  • further action should be taken to protect the adult from abuse or neglect.

These decisions are made by the relevant team manager in consultation with the adult and other parties involved in the enquiry.

16.1 What happens after an enquiry?

Once the wishes of the adult have been understood and an initial enquiry undertaken, discussions should be undertaken with the adult as to whether further enquiry is needed and what further action could be taken. That action could take a number of courses including:

  • disciplinary action;
  • complaints;
  • criminal investigations; or
  • work by contracts managers and CQC to improve care standards.

The discussions should help the adult to understand what their options might be and how their wishes might best be achieved.

Social workers must be able to set out all options that are open (including action in the civil and criminal courts) as well as other support that might help to promote their wellbeing, such as therapeutic or family work, mediation and conflict resolution, peer or circles of support.

In complex domestic circumstances, it may take the adult some time to gain the confidence and self-esteem to protect themselves and take action, and it should be noted that their wishes may change over time. The police, health service and others may need to be involved to help ensure these wishes are realised.

17. Evaluation by the Adult

The following should be established with the adult concerned:

  1. Were the desired outcomes met? In exploring this, there is a need to clarify whether they were:
    a. Fully met; b.Partially met; c. Not met.
  2. Do they feel safer as a result of the safeguarding enquiry and protection plan?

a. Yes;

b. Partially – in some areas but not others;

c. No

If the adult does not feel safer at the end of the episode further actions to establish realistic outcomes and protection planning, directed by the adult should continue.

The evaluation is that of the adult, and not of other parties. Whilst staff may consider that enquiry and actions already taken have made the adult safe, and that their outcomes were met, the important factor is how actions have impacted on the adult. This should be clarified when assessing the performance of safeguarding.

18. Outcome for the Person/s Alleged to have caused Harm

To ensure the safety and wellbeing of other people, it may be necessary to take action against the person / organisation alleged to have caused harm. Where this may involve a prosecution, the police and the Crown Prosecution Service lead sharing information within statutory guidance.

The police may also consider action under the Common Law Police Disclosure (CLPD)  which are the name for the system that has replaced the ‘Notifiable Occupations Scheme’. The CLPD addresses risk of harm regardless of the employer or regulatory body and there are no lists of specific occupations. The CLPD focuses on:

  • disclosure where there is a public protection risk;
  • disclosures are subject to thresholds of ‘pressing social need’.

The ‘pressing social need’ threshold for making a disclosure under common law powers is considered to be the same as that required for the disclosure of non-conviction information by the Disclosure and Barring Service (DBS) .

18.1 Referrals to professional bodies

Where it is considered that a referral should be made to the DBS careful consideration should be given to the type of information needed. This is particularly pertinent for people in a position of trust. Where appropriate, employers should report workers to the statutory and other bodies responsible for professional regulation such as the General Medical Council (GMC), the Nursing and Midwifery Council, Social Work England and the Health and Care Professions Council. The legal duty to refer to the Disclosure and Barring Service may apply regardless of a referral to other bodies (see Appendix 3, Workforce Development).

19. Support for People who are Alleged to have Caused Harm

Where the person is also an adult who has care and support needs, organisations should consider what support and actions may help them not to abuse others. For example, enquiries may indicate that abuse was caused because the adult’s needs were not met and therefore a review of their needs should be made. Where the person alleged to have caused harm is a carer, consideration should be given to whether they are themselves in need of care and support.

Checks might be made whether staff were provided with the right training, supervision and support. Whilst this does not condone deliberate intentions of abuse, prevention strategies to reduce the risk of it occurring again to the adult or other people should be considered. People who are known perpetrators of domestic abuse may benefit from Domestic Abuse Perpetrators Programmes (see South Tyneside Domestic Abuse Perpetrators Programme).

When considering action for people who abuse, prevention and action to safeguard adults should work in tandem.

20. Recovery and Resilience

Adults who have experienced abuse and neglect may need to build up their resilience. This a process whereby people use their own strengths and abilities to overcome what has happened, learn from the experience and have an awareness that may prevent a reoccurrence, or at the least, enable people to recognise the signs and risks of abuse and neglect, and know how and who to contact for help.

Resilience is supported by recovery actions, which includes adults identifying actions that they would like to see to prevent the same situation arising. The process of resilience is evidenced by:

  • the ability to make realistic plans and being capable of taking the steps necessary to follow through with them;
  • a positive perception of the situation and confidence in the adult’s own strengths and abilities;
  • increasing their communication and problem solving skills.

Resilience processes that either promote wellbeing or protect against risk factors, benefits individuals and increases their capacity for recovery. This can be done through individual coping strategies assisted by:

  • strong personal networks and communities;
  • social policies that make resilience more likely to occur;
  • handovers/referrals to other services for example care management, or psychological services to assist building up resilience;
  • restorative practice.

If no further safeguarding action is required and there are alternative ways of supporting adults where they may be needed, then the adult safeguarding process can be closed down.

Actions and Decisions under Section 42 Enquiries (Stage 2)
Actions
  • Plan the enquiry
  • Identify enquiry lead
  • Clarify desired outcomes
  • Identify links to other procedures in progress
  • Undertake agreed action
  • Update safeguarding plan
  • Agree communication
  • Agree outcomes for person/s alleged to have caused harm
  • Make referrals as agreed in relation to the person alleged to have caused harm
  • Make referrals in relation to the adult
  • Evaluation by the adult / advocate
  • Explore recovery and resilience.
 The relevant team manager in consultation with the adult / advocate
Decisions
  • What type of enquiry is appropriate and proportionate
  • Who should lead and who should contribute
  • Does the report meet standards?
  • Necessary for the enquiry to be taken over by the local authority
  • Whether to close the enquiry down or take forward for review
  • Actions for the adult
  • Actions for the person alleged to have caused harm.
 The relevant team manager in consultation with the adult / advocate and others
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RELEVANT CHAPTERS

Stage 2: Enquiry

Making Safeguarding Personal

RELEVANT INFORMATION

What Constitutes a Safeguarding Concern and how to Carry out an Enquiry (Local Government Association)

 

1. What is an Adult Safeguarding Concern?

An adult safeguarding concern is any worry about an adult who has or appears to have care and support needs that they may be subject to, or may be at risk of, abuse and neglect and may be unable to protect themselves against this.

It is the responsibility of all staff (practitioners and volunteers) to act on any suspicion or evidence of abuse and neglect and to pass on their concerns to a responsible person or agency.

Workers across a wide range of agencies need to be vigilant about adult safeguarding concerns and act appropriately when dealing with such concerns.

It should never be assumed that someone else will pass on information which may be critical to the safety and wellbeing of the adult. All staff have a duty of care to pass on their concerns and would be failing in this duty if they failed to do so.

A concern may be raised by anyone, and can be:

  • an active disclosure of abuse by the adult, where the adult tells another person that they are experiencing abuse and / or neglect
  • or believes they are at risk of abuse and/or neglect;
  • a passive disclosure of abuse where someone has noticed signs of abuse or neglect, for example clinical staff who notice unexplained injuries;
  • an allegation of abuse by a third party, for example a family member, friend or neighbour who have observed abuse or neglect or has been told by the adult;
  • a complaint or concern raised by an adult or a third party who does not perceive that it is abuse or neglect. Complaint officers should consider whether there are safeguarding matters;
  • a concern raised by staff or volunteers, others using the service, a carer or a member of the public;
  • an observation of the behaviour of the adult;
  • An observation of the behaviour of another;
  • patterns of concerns or risks that emerge through reviews, audits and complaints or regulatory inspections or monitoring visits (Care Quality Commission, NHS England etc).
Initial Action and Decision Making under Section 42 (Stage 1)
Action
  1. Establish the adult is safe and in no immediate danger;
  2. Establish need for advocacy;
  3. Establish consent and capacity to make relevant decisions by understanding the management of risk, what a safeguarding enquiry is, how they might protect themselves;
  4. Is the adult aware of the safeguarding concern and do they perceive it as a concern and want action / support?
  5. Is there suspicion that a crime may have been committed and a report to the police needed?
  6. The adult’s desired outcome is established;
  7. Provide feedback to the person making the referral;
  8. Record all actions and conversations;
  9. Although staff should do what they can to ensure the immediate safety of an adult, they must not put themselves in risky or dangerous situations;
  10. Staff should contact their line manager, or delegated other, as soon as practicable, to inform them of the situation and seek further advice.
 Enquiry Lead
Decisions
  1. Who is best placed to speak with the adult?
  2. Are there any reasons to delay speaking with the adult?
  3. What the safeguarding enquiry might consist of?
  4. Whether to proceed without consent;
  5. What follow-up action may be needed;
  6. Whether actions so far have completed the enquiry.
 Relevant team manager

Concerns can be raised in person by contacting the South Tyneside Let’s Talk Team (see Local Contacts). Professionals, however, should submit referrals using the Multi Agency Safeguarding Adults Referral Form (see Forms, Leaflets and Posters).

Concerns may also be raised through other locally agreed specific organisation processes. For example, Adult Concern Notifications (ACN) are reports completed by operational police officers and sent to the local authority where there are concerns about people who may be adults at risk, whether they are a victim, witness, suspect or member of the public. The police will make a decision about whether to refer to the local authority using their own operational toolkit. Some concerns may not sit under adult safeguarding processes, but remain concerns that may require other action. All concerns should be responded to, and SABs should be satisfied that concerns are being addressed appropriately through their oversight of safeguarding practice.

2. Involving the Police

The police will always be responsible for the gathering and preservation of evidence to pursue criminal allegations against people causing harm, and should be contacted immediately.

All employees are authorised to call emergency services, without referral to a manager, to ensure that there is no delay.

Staff contact with the police will fall mainly into four main areas:

  1. reporting a crime – if an individual witnesses a crime, they have a duty to report it to the police;
  2. third party reporting of a crime – if an individual is made aware of a crime, they should support the adult to report to the police, or make a best interest decision to do so. In domestic abuse situations practitioners should be aware of the principles of ‘safe enquiries’;
  3. consultation with the police – seeking advice;
  4. sharing intelligence and managing risk.

Where the safeguarding concerns arise from abuse or neglect deliberately intended to cause harm, then it will not only be necessary to immediately consider what steps are needed to protect the adult but also how best to report as a possible crime. Early engagement with the police is vital to support the criminal investigation.

3. Action by other Professionals

Immediate Action by the Person Raising the Concern (Professionals)
The person who raises the concern has a responsibility to first and foremost safeguard the adult.

  1. Make an evaluation of the risk and take steps to ensure that the adult is in no immediate danger;
  2. Arrange any medical treatment. (Note that offences of a sexual nature will require expert advice from the police);
  3. If a crime is in progress or life is at risk, dial emergency services – 999;
  4. Encourage and support the adult to report the matter to the police if a crime is suspected and not an emergency situation;
  5. Take steps to preserve any physical evidence if a crime may have been committed;
  6. Discourage washing / bathing / eating / drinking / smoking and not cleaning or allowing further use by others of a toilet used by the victim since the alleged incident in cases of sexual assault;
  7. Not handling items which may hold DNA evidence;
  8. Put any bedding, clothing which has been removed, or any significant items (weapons etc) in a safe dry place in bags (for example bin liners) if possible;
  9. Preserve evidence through recording;
  10. Ensure that other people are not in danger;
  11. If you are a paid employee, inform your manager. Report the matter internally through your internal agency reporting procedures
  12. Record the information received, risk evaluation and all actions.
  13. Contact the children and families department if a child or young person is also at risk.
Service / Organisation’s Safeguarding Lead
 The service / organisation’s safeguarding lead should review the action taken and:

  1. clarify that the adult is safe, that their views have been clearly sought and recorded and that they are aware what action will be taken;
  2. address any gaps;
  3. check that issues of consent and mental capacity have been addressed;
  4. in the event that a person’s wishes are being overridden, check that this is appropriate and that the adult understands why;
  5. contact the children and families department if a child or young person is also at risk;
  6. make sure action is taken to safeguard other people;
  7. take any action in line with disciplinary procedures; including whether it is appropriate to suspend staff or move them to alternative duties;
  8. if your service is registered with the CQC, and the incident constitutes a notifiable event or incident, complete and send a notification to them;
  9. in addition, if a criminal offence has occurred or may occur, contact the police force where the crime has / may occur;
  10. preserve forensic evidence and consider a referral to the Sexual Assault Referral Centre (SARC), and taking advice from expert organisation for example the police or SARC;
  11. make a referral under Prevent if appropriate (see Adults Vulnerable to Exposure to Extremist Ideology);
  12. consider if the case should be put forward for a Safeguarding Adults Review (SAR);
  13. record the information received and all actions and decisions.

4. Decision Making: Pre-Referral to the Local Authority

The safeguarding lead in the service / organisation will usually lead on decision making. Where such support is unavailable, consultation with other more senior staff should take place. In the event that this is not possible, advise should be sought from South Tyneside Let’s Talk Team (see Local Contacts).

Staff should take action without the immediate authority of a line manager:

  • if discussion with the manager would involve delay in an apparently high risk situation;
  • if the person has raised concerns with their manager and they have not taken appropriate action (whistleblowing).

Decisions need to take into account all relevant information that is available, including the views of the adult in all circumstances where it is possible and safe to seek their views. If the adult does not want to pursue matters through formal safeguarding action overseen by the local authority, staff should be sure that the adult is fully aware of the consequences of their decisions, and that all options have been explored and that not proceeding further is consistent with legal duties.

There may be some occasions when the adult does not want to pursue a referral to the local authority. Where it is a personal matter and may cause family disharmony, if possible the adult’s wishes should be respected and other ways of ensuring the adult’s safety explored. Where there is a potentially high risk situation, staff should be vigilant of possible coercion and the emotional or psychological impact that the abuse may have had on the adult.

Decision makers also need to take account of whether or not there is a public or vital interest to refer the concern to the local authority. Where there is a risk to other adults, children or young people or there is a public interest to take action because a criminal offence had occurred and the view is that it is a safeguarding matter, the wishes of the individual may be overridden. Where the sharing of information to prevent harm to others is necessary, lack of consent to information sharing can also be overridden (see the chapter on Consent in relation to Safeguarding).

In the event that people lack the capacity to provide consent, action should be taken in line with the Mental Capacity Act 2005. Where a possible crime has been committed the adult should always be encouraged to report the matter to the police. Professionals, however, also have a duty to report the matter to the police.

Good Practice Guidance: Disclosure
Disclosures should be listened to and recorded carefully as soon as possible – using the person’s own words where possible.

  • Speak in a private and safe place;
  • Accept what the person is saying and not be judgmental;
  • Don’t ‘interview’ the person, but establish the basic facts avoiding asking the same questions more than once;
  • Ask them what they would like to happen and what they would like you to do;
  • Do not promise the person that you will keep what they tell you confidential – explain who you will tell, and why;
  • If there are grounds to override a person’s consent to share information, explain what these are;
  • Explain how the adult will be involved and kept informed;
  • Provide information and advice on keeping safe and the safeguarding process;
  • Make a best interest decision about the risks and protection needed if the person is unable to provide informed consent.

Establish:

  • The risks and what immediate steps to take;
  • Communication needs, whether an interpreter or other support is needed for example;
  • Whether it is likely that advocacy may be required;
  • Personal care and support arrangements;
  • Mental capacity to make decisions about whether the adult is able to protect themselves and understand the safeguarding process.
Concerns Checklist
Action Comment
Safety of adult and others made
Initial conversation held with the adult
Emergency services contacted and recorded
Medical treatment sought
Consent sought
Mental Capacity considered
Best Interest Decisions made and recorded
Public and vital interest considered and recorded
Police report made
Evidence preserved
Referrals to specialist agencies e.g. Reach and Prevent
Referral to children services if there are children and young people safeguarding matters
Action taken to remove/reduce risk where possible and recorded
Recorded clear rationales for decision making
Referral to local authority included relevant information

5. Referral to the Local Authority

If, on the basis of the information available, it appears that the following three steps are met a referral must be made to the local authority.

Referrals from professionals should be made using the Multi Agency Safeguarding Adults Referral Form (see Forms, Leaflets and Posters).

5.1 Information the referral should contain

  • Organisations that refer to the local authority should include the following information:
  • demographic and contact details for the adult, the person who raised the concern and for any other relevant individual, specifically carers and family / advocate;
  • basic facts, focussing on whether or not the person has care and support needs including communication and ongoing health needs;
  • factual details of what the concern is about – what, when, who, where;
  • immediate risks and action taken to address risk;
  • preferred method of communication;
  • if reported as a crime – details of which police station / officer, crime reference number etc;
  • whether the adult has  care and support needs which may impede their ability to protect themselves;
  • any information on the person alleged to have caused harm;
  • wishes and views of the adult with desired outcomes;
  • capacity to consent to the referral;
  • consent to the referral;
  • advocacy involvement (includes family / friends);
  • information from other relevant organisations for example, CQC;
  • any recent history (if known) about previous concerns of a similar nature or concerns raised about the same person, or someone within the same household.
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RELEVANT CHAPTER

Making Safeguarding Personal

RELEVANT GUIDANCE

Using the Inherent Jurisdiction in Relation to Adults (39 Essex Chambers)

SOUTH TYNESIDE INFORMATION

Multi Agency Safeguarding Adults Referral Form

South Tyneside Safeguarding Adults Thresholds Guidance Tool (2023)

1. Context

The main objective of adult safeguarding procedures is to provide guidance to enable adults to be kept safe from abuse or neglect and immediate action to be taken where required in order to achieve this.

These procedures are a means for staff to combine principles of protection and prevention with individuals’ self-determination, respecting their views, wishes and preferences in accordance with Making Safeguarding Personal . They are a framework for managing safeguarding interventions that are fair and just, through strong multi-agency partnerships that provide timely and effective prevention of and responses to abuse and neglect. All organisations who work with or support adults experiencing, or who are at risk of, abuse and neglect may be called upon to lead or contribute to a safeguarding concern and need to be prepared to take on this responsibility.

Guidance is often criticised for over-standardising practice and undervaluing the skills required when applying policies in diverse circumstances. The key focus is on using professional skills to gain a real understanding of what adults want to achieve and what action is required to help them to achieve it.

2. The Four Stage Process

These procedures has been structured within a four stage process:

Before going through each stage of the process in depth, the next section will define roles and responsibilities and provide context within which the procedures operate.

3. Responsibilities

3.1 Local Authority and NHS partnerships

‘Local authorities can continue to enter into partnership arrangements with the NHS for the NHS to carry out a Local Authority’s ‘health-related functions’ (as defined in the 2000 Regulations (NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000). This effectively authorises NHS bodies to exercise those prescribed functions, including adult safeguarding functions. These arrangements are partnership arrangements rather than delegation’. In addition, arrangements may only be entered into ‘if the partnership arrangements are likely to lead to an improvement in the way in which those functions are exercised’. The local authority remains legally responsible for how its functions (including adult safeguarding) are carried out via partnership arrangements.

3.2 Safeguarding leads in all organisations

Safeguarding adults lead throughout these procedures means the staff member responsible in organisations to provide:

  • managerial support and direction to staff in that organisation;
  • decision making for concerns raised by members of staff and / or members of the public.

3.3 Safeguarding adult referral points

Each organisation must have its own operational policy on how it manages adult safeguarding concerns, including a list of referral points with up to date contact details, so that staff and the public know how to report abuse and neglect. During offices hours, the Let’s Talk Service is the main referral point. Over the weekend and on evenings, the there emergency duty team should be contacted (see Local Contacts).

3.4 Enquiry lead

An enquiry lead is responsible for coordinating actions under adult safeguarding, supported by other staff.

3.5 Safeguarding Adults Manager

The Safeguarding Adults Manager (SAM) is the local authority member of staff who manages, makes decisions, provides guidance and has oversight of safeguarding concerns that are referred to the local authority.

4. Feedback

All adult safeguarding concerns referred to the local authority should be assessed to decide if the criteria for adult safeguarding are met. Keeping the person who raised the concern informed is an essential requirement under these policies and procedures. Feedback provides assurance that action has been taken whether under adult safeguarding or not. Organisations or individuals raising concerns may want to challenge or discuss decisions and need to be updated on what action has been taken.

It is more likely that the public will continue to raise concerns, where there is an acknowledgement that their concern has reached the right agency and is being taken seriously. Feedback to the wider community needs to take account of confidentiality and requirements of the Data Protection Act 2018 (DPA).

4.1 Feedback to people alleged to have caused harm

The principles of natural justice must be applied, consistently with the overriding aim of safety and the requirements of the DPA. Providing information on the nature and outcomes of concerns to people alleged to have caused harm also needs to be seen in the wider context of prevention; for example, information can be used to support people to change or modify their behaviour. The person / organisation that is alleged to be responsible for abuse and / or neglect should be provided with sufficient information to enable them to understand what it is that they are alleged to have done or threatened to do that is wrong and to allow their view to be heard and considered.

Whilst the safety of the adult remains paramount, the right of reply should be offered where it is safe to do so. Decision making should take into consideration:

  • the possibility that the referral may be malicious;
  • the right to challenge and natural justice;
  • whether there are underlying issues for example employment disputes;
  • family conflict;
  • relationship dynamics;
  • whether it is safe to disclose particularly where there is domestic abuse;
  • compliance with the Mental Capacity Act 2005.

Feedback should be provided in a way that will not exacerbate the situation, or breach the DPA. If the matter is subject to police involvement, the police should always be consulted so criminal investigations are not compromised.

5. Dealing with Repeat Allegations

All concerns should be considered on their own merit. An adult who makes repeated allegations that have been investigated and decided to be unfounded should be treated without prejudice. Where there are patterns of similar concerns being raised by the same adult within a short time period, a risk assessment and risk management plan should be developed and a process agreed for responding to further concerns of the same nature from the same adult.

All organisations are responsible for recording and noting where there are such situations and may be asked to contribute to a multi-agency response. Information sharing to assess and analyse data is essential to ensure that adults are safeguarded and an appropriate response is made. Staff should also be mindful of public interest issues.

In considering how to respond to repeated concerns the following factors need to be considered:

  • the safety of the adult who the concern is about;
  • mental capacity and ability of the support networks of the individual to raise the concern, if appropriate, or they are the adult, to increase support to meet outcomes of safeguarding concerns;
  • wishes of the adult and impact of the concern on them;
  • impact on important relationships;
  • level of risk.

6. Dispute Resolution and Escalation

Professional disagreements should be resolved at the earliest opportunity, ensuring that the safety and wellbeing of the adult remains paramount. Challenges to decisions should be respectful and resolved through co-operation. Disagreements can arise in a number of areas and staff should always be prepared to review decisions and plans with an open mind. Assurance that the adult is safe takes priority. Disagreements should be talked through and appropriate channels of communication established to avoid misinterpretation.

In the event that operational staff are unable to resolve matters, more senior managers should be consulted with liaison between managers from different organisations where a number of agencies are involved. Multi-agency network meetings can be a helpful way to explore issues with a view to improving practice. In exceptional circumstances or where it is likely that partnership protocols are needed, the Safeguarding Adults Board should be informed. In the case of care providers, unresolved disputes should be raised with the relevant managers leading on the concern and with commissioners.

7. Cross-Boundary and Inter-Authority Adult Safeguarding Enquiries

Risks may be increased by complicated cross-boundary arrangements, and it may be dangerous and unproductive for organisations to delay action due to disagreements over responsibilities. The rule for managing safeguarding enquiries is that the local authority for the area where the abuse occurred has the responsibility to carry out the duties under the Care Act, but there should be close liaison with the placing local authority.

The placing authority continues to hold responsibility for commissioning and funding a placement. However, many people at risk live in residential settings outside the area of the placing authority. In addition, a safeguarding incident might occur during a short-term health or social care stay, or on a trip, requiring police action in that area or immediate steps to protect the person while they are in that area.

The initial lead in response to a safeguarding concern should always be taken by the Local Authority for the area where the incident occurred. This might include taking immediate action to ensure the safety of the person, or arranging an early discussion with the police when a criminal offence is suspected. Further action should then be taken in line with Making Safeguarding Personal on the views of the adult, and the Care and Support Statutory Guidance on who is best placed to lead on an enquiry

8. Timescales

The adult safeguarding procedures do not set definitive timescales for each element of the process; however, target timescales are indicated. South Tyneside Safeguarding Adults Board and / or the local authority may make additional decisions on timescales over and above this for their own performance monitoring. Local guidance on timescales reflects the ethos of the Making Safeguarding Personal agenda. It is important that timely action is taken, whilst respecting the principle that the views of the adult are paramount. It is the responsibility of all agencies proactively to monitor concerns to ensure that drift does not prevent timely action and place people at further risk. Divergence from any target timescales may be justified in particular where:

  • adherence to the agreed timescales would jeopardise achieving the outcome that the adult wants;
  • it would not be in the best interests of the adult;
  • significant changes in risk are identified that need to be addressed;
  • supported decision making may require an appropriate resource not immediately available;
  • a persons’ physical, mental and / or emotional wellbeing may be temporarily compromised.
Indicative Timescales
Stage One: Concerns – Referrals to South Tyneside Safeguarding Adults Team

 
  • Immediate action in cases of emergency;
  • Within one working day in other cases;
  • Initial fact finding coordinated by Safeguarding Adults Team within three working days, liaising with all agencies involved (this is later referred to as the planning discussion).
Stage Two: Enquiries
  • Section 42 Enquiry;
  • Enquiry lead identified;
  • Enquiry Actions, within 20 working days, liaising with relevant agencies;
  • In complex cases the SAM convenes multi agency complex case meeting;
  • Enquiry lead produces report for the SAM within agreed timescale;
  • Feedback to referrer.
Stage Three:   Safeguarding Plan and Review 
  • Enquiry lead produces safeguarding plan, in consultation with the SAM within agreed timescales;
  • SAM to coordinate a review and set a timescale, if appropriate, once plan is finalised;
  • Timescales as agreed in safeguarding plan.
Stage Four: Closing the Enquiry
  • Actions immediately following decision to close where possible; Other actions relating to safeguarding process within 5 working days;
  • Feedback to referrer.
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1. Introduction

Risk taking is part of daily life and does bring benefits, including wellbeing (see Promoting Wellbeing). The evaluation and management of risk, therefore, is an essential part of the assessment process and is a necessary for identifying an adult’s level of need and eligibility for services. Not all risks can be eradicated, but they can be managed to prevent or reduce the impact of harm.

Some risks are general and some specific, but in each case risk should be defined in relation to a specific situation, that is, what is the presenting risk and /or who or what is the risk. Undertaking a comprehensive risk assessment involves collating evidence based information, evaluating that information – balancing possible positives of a course of action against potential drawbacks – and using professional judgment to ascertain the potential for the occurrence of harm.

Within organisations, lines of accountability with other agencies should be established for high risk areas, and a clear management reporting structure should be in place.

Staff undertaking risk assessments should be competent and able to evaluate and act upon a risk of danger, harm or abuse. Staff should therefore know how to reduce or remove risk. Ongoing risk management tasks include staff supervision.

In high risk situations staff should be debriefed on the outcomes of the assessment, enabling them to gain insight into their work, their personal stress, their decisions and the appropriate plan of action.

2. Types of Risk

Professionals undertaking the risk assessment should be aware of the different types of risk that may exist. These may include risks in four main areas:

  1. physical health;
  2. mental health;
  3. emotional wellbeing;
  4. social circumstances.

Risk should be considered in terms of the likely risk to:

  • the person;
  • others including care staff, carers, visitors and social workers;
  • the wider community including neighbours or other residents of the area or care home.

Types of risk may include the following:

  • the physical environment, for example an unsafe home conditions;
  • mental health issues which result in, for example confusion, wandering, leaving the gas on;
  • the adult’s behaviour, for example fire setting or aggression;
  • major life changes, such as bereavement / loss, moving to residential care;
  • health issues refusing medication;
  • a poorly managed service;
  • sharing accommodation or services with people who have violent behaviour;
  • relationships including emotional, physical, financial or sexual abuse or neglect.

3. Involving the Adult

Making Safeguarding Personal (MSP) stresses the importance of keeping the adult at the centre of the process. Under MSP the adult is best placed to identify risks, provide details of its impact and whether or not they find the mitigation acceptable. Working with the adult to lead and manage the level of risk that they identify as acceptable creates a culture where:

  • adults feel more in control;
  • adults are empowered and have ownership of the risk;
  • there is improved effectiveness and resilience in dealing with a situation;
  • there are better relationships with professionals;
  • good information sharing to manage risk, involving all the key stakeholders (see Information Sharing, as above);
  • key elements of the person’s quality of life and wellbeing can be safeguarded.

4. Identifying Risk

Not every situation or activity will entail a risk that needs to be assessed or managed. The risk may be minimal and no greater for the adult, than it would be for any other person.

  • Risks can be real or potential;
  • Risks can be positive or negative;
  • Risks should take into account all aspects of an individual’s wellbeing and personal circumstances.

Sources of risk might fall into one of the four categories below:

  1. private and family life: the source of risk might be someone like an intimate partner or a family member;
  2. community based risks: this includes issues like ‘mate crime’, anti-social behaviour, and gang-related issues;
  3. risks associated with service provision: this might be concerns about poor care which could be neglect or organisational abuse, or where a person in a position of trust because of the job they do financially or sexually exploits someone;
  4. self-neglect: where the source of risk is the person themselves.

5. Risk Assessment

Risk assessment involves collecting and sharing information through observation, communication and investigation. It is an ongoing process that involves persistence and skill to assemble and manage relevant information in ways that are meaningful to all concerned. Risk assessment that includes the assessment of risks of abuse, neglect and exploitation of people should be integral in all assessment and planning processes, including assessments for self-directed support and the setting up of personal budget arrangements.

Adequate risk assessment can rarely be done by one person alone and a coordinated approach is required. Good relationships between professionals and the adult and their carers makes the assessment easier and more accurate, and may indeed reduce risk.

A risk assessment needs to identify and balance different perceptions of risk, including the adult, their carers and professionals; the adult’s right to make informed choices about taking risks should be safeguarded and encouraged. Decisions about risk, however, do need to balance any risk to the public and the needs and wishes of the adult.

If the adult lacks capacity to make decisions, the risk assessment must take account of the views of family members or friends important to the adult and who have an interest in their welfare or, where appointed, their Attorney or Independent Mental Capacity Advocate (see Independent Advocacy and Independent Mental Capacity Advocates and Independent Mental Health Advocates).

The professional undertaking the assessment must be supported throughout the process by their manager, to ensure all aspects of the situation have been understood, evaluated and the views of the adult, their Attorney and / or Advocate where appointed and other agencies and service providers have been considered. The professional undertaking the assessment should ensure a referral for an IMCA is made, where appropriate, to protect an unsupported person who lacks capacity to make a decision.

See Supervision.

A multi-disciplinary approach should form the basis of the risk assessment process. Information should be collated from a variety of sources and agencies. Contributions from agencies such as the police, probation and the adult’s GP should always be considered at each stage in the process.

It is important that organisations ensure that appropriate tools are available to support staff to evidence professional judgement during their decision making. Issues around information sharing may be relevant in this context (see South Tyneside Multi Agency Information Sharing Agreement).

Assessment of risk is dynamic and ongoing, and a flexible approach to changing circumstances is needed. The primary aim of a safeguarding adults risk assessment is to assess current risks that people face and potential risks that they and other adults may face. Specific to safeguarding, risk assessments should encompass:

  • the history including patterns of behaviour/previous incidents, non-compliance with services;
  • the severity of the risk;
  • the views and wishes of the adult and their motivation to manage the situation;
  • the person’s ability to protect themselves;
  • factors that contribute to the risk, for example, personal, environmental
  • the risk of future harm from the same source;
  • identification of the person causing the harm and establishing if the person causing the harm is also someone who needs care and support;
  • deciding if domestic abuse is indicated and the need for a referral to a MARAC (see MARAC Referral Form);
  • deciding if a multi-agency complex panel meeting is needed;
  • identify people causing harm who should be referred to MAPPA;
  • it may increase risk where information is not shared.

6. Risk Management

The focus must be on the management of risks not just a description of risks. Employers need to take responsibility for the management of risk within their own organisation and share information responsibly where others may be at risk from the same source. The local authority may be ultimately accountable for the quality of Section 42 Care Act enquiries, but all organisations are responsible for supporting holistic risk management, with the adult and in partnership with other agencies.

It is the collective responsibility of all organisations to share relevant information, make decisions and plan intervention with the adult. A plan to manage the identified risk and put in place safeguarding measures includes:

  • what immediate action must be taken to safeguard the adult and / others;
  • who else needs to contribute and support decisions and actions;
  • what the adult sees as proportionate and acceptable;
  • what options there are to address risks;
  • when action needs to be taken and by whom;
  • what the strengths, resilience and resources of the adult are;
  • what needs to be put in place to meet the on-going support needs of the adult; What the contingency arrangements are;
  • how will the plan be monitored?

Positive risk management needs to be underpinned by widely shared and updated contingency planning for any anticipated adverse eventualities. This includes warning signs that indicate risks are increasing and the point at which they become unacceptable and therefore trigger a review.

Effective risk management requires exploration with the adult using a person-centred approach, asking the right questions to build up a full picture. Not all risks will be immediately apparent; therefore risk assessments need to be regularly updated as part of the safeguarding process and possibly beyond.

7. Decision Making and Risk Management Plan

The professional should conclude how serious the risk is, how specific it is and its immediacy.

Not every adult will require a risk management plan, but where there are concerns, a plan should be developed. The risk management plan should:

  • identify each risk and detail the measures taken or services applied to remove or reduce it;
  • identify who is responsible for each aspect of the required monitoring;
  • identify and plan the frequency of reviews;
  • identify who is responsible for coordinating reviews;
  • identify the role and contribution of each agency in the management of the identified risk/s;
  • contain a contingency plan in case of emergency or in response to risks identified.

8. Reviewing Risk

Individual need will determine how frequently risk assessments are reviewed and wherever possible there should be multi-agency input. These should always be in consultation with the adult.

9. Risk Disputes

Throughout these policies and procedures, risk assessment and risk management is carried out in partnership with the adult, wider support network and others. The decision to involve others or not is in itself a decision which may give rise to risk, and the individual may need support to make this decision.

The professional views of risk may differ from the views of the adult. Perceived risks have implications for the safety and the independence of the individual, but they also have implications for the accountability of professionals. This highlights the importance of training and/or regular practice in making independent decisions by adults. Accessible knowledge through information and advice, assertiveness through the right kind of advocacy and support may be appropriate.

Professionals need to embrace and support positive risk taking by finding out why the person wishes to make a particular choice, what this will bring to their life, and how their life may be adversely affected if they are not supported in their choice. The promotion of choice and control, of more creative and positive risk taking, implies greater responsibility on the part of the adult and greater emphasis on keeping them at the centre of decision making.

It may not be possible to reach agreement, but professionals need to evidence that all attempts to reach agreement were taken. Where there are concerns about people making unwise decisions, or there is high risk that requires wider collaboration; a Multi-Agency Risk Panel is one model used to support safeguarding adults processes.

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1. Deprivation of Liberty

A deprivation of liberty can occur in any care setting and is when a person has their freedom limited in some way.

Schedule 1, Part 1, Section 5(4) of the Human Rights Act, 1998, states that ‘everyone who is deprived of his [their] liberty by arrest or detention shall be entitled to take proceedings by which the lawfulness of his [their] detention shall be decided speedily by a court and his [their] release ordered if the detention is not lawful’.

In England and Wales, the Deprivation of Liberty Safeguards (DoLS) are used to check that actions which limit the liberty of a person who does not have the capacity to consent to this, are done in the least restrictive way necessary to keep them safe and that it is in their best interests.

DoLS provides a process for a deprivation of liberty to be made legal through either ‘standard’ or ‘urgent’ authorisation processes. These processes are designed to prevent the making of arbitrary decisions to deprive a person of liberty. They also give people a right to challenge deprivation of liberty authorisations.

2. Identifying Deprivation of Liberty

In 2014, a ruling by the Supreme Court (P v Cheshire West and Chester Council and P&Q v Surrey County Council, March 2014 P v Cheshire West and Chester Council and P&Q v Surrey County Council, March 2014) held that, as well as hospitals and registered care homes, a deprivation of liberty can also occur in domestic / home type settings where the state is responsible for enforcing such arrangements. This may include a placement in a supported living arrangement in the community and in a person’s own home. Where a deprivation of liberty occurs outside of a hospital or registered care home, it must be authorised by the Court of Protection. See Section 11, Deprivation of Liberty outside a Hospital or Registered Care Home Setting.

It is crucial that all care providers can recognise when a person might be deprived of their liberty by applying the acid test (see Section 3, The Acid Test) and then take the required action by applying for an authorisation to the supervisory body / Court of Protection. This extends to all hospitals and registered care homes, domiciliary care providers, and day services.

Associated health and social care professionals must also be able to identify a potential deprivation of liberty, and know how to notify the supervisory body of deprivation of liberty which may be unauthorised.

3. The Acid Test

In its 2014 ruling, the Supreme Court clarified that there is a deprivation of liberty where the person:

  • is under continuous supervision and control (all 3 of these aspects are required);
  • is not free to leave;
  • lacks capacity to consent to these arrangements; and
  • their confinement is the responsibility of the State.

This means that if a person who lacks capacity to consent to this is subject to continuous supervision and control and are is free to leave they are deprived of their liberty.

The following factors are not relevant to determining if there is a deprivation of liberty:

  • the person’s compliance or lack of objection;
  • the reason or purpose behind a particular placement; and
  • the extent to which it enables them to live a relatively normal life for someone with their level of disability.

See also Deprivation of Liberty Safeguards: At a Glance (SCIE) 

Practice Guidance

When staff are working with people who may be deprived of their liberty, always consider the following:

Mental Capacity Act principles: the five principles and specifically “considering less restrictive arrangements” principle (see Mental Capacity chapter);

Restrictions and restraint: when designing and implementing new care and treatment plans for individuals lacking capacity, be alert to any restrictions and restraint which may be of a degree or intensity that mean an individual is being, or is likely to be, deprived of their liberty (following the acid test supplied by the Supreme Court);

Less restrictive alternative: where a potential deprivation of liberty is identified, a full exploration of the alternative ways of providing the care and/ or treatment should be undertaken by the allocated worker, in order to identify any less restrictive ways of providing that care which will avoid a deprivation of liberty;

16-17 years olds: A Court of Protection judgement – Birmingham City Council v D (January 29, 2016) – widened the acid test to apply to 16 and 17 year olds who lack capacity.

4. Restrictions and Restraint

There is a difference between a deprivation of liberty (which is unlawful, unless authorised) and restrictions on a person’s freedom of movement.

Restrictions of movement (if in accordance with the principles and guidance in the Mental Capacity Act 2005 (MCA)) can be lawfully carried out in a person’s best interests, in order to prevent harm. This includes use of physical restraint where that is proportionate to the risk of harm to the person and in line with best practice.

Examples of restraint and restrictions include:

  • using locks or keypads to prevent a person leaving a specific area;
  • administration of certain medication, for example to calm a person;
  • requiring a person to be supervised when outside;
  • restricting contact with family and friends, including if they could harm the person;
  • physical intervention to stop someone from doing something which could harm themselves;
  • removing items from a person which could harm them;
  • holding a person so they can be given care or treatment;
  • using bedrails, wheelchair straps, and splints;
  • requiring close supervision / monitoring in the home;
  • the person having to stay somewhere they do not want;
  • the person having to stay somewhere their family does not want.

5. The Deprivation of Liberty Safeguards Process

5.1 Making an application for a standard authorisation

There are several stages involved in authorising a deprivation of liberty.  It is the local authority’s legal duty, as the supervisory body, to ensure that where a person is being deprived of their liberty in a hospital or a registered care home, or a deprivation of liberty is being proposed, that steps are taken to safeguard them. This only applies to people where they are ‘ordinarily resident’. The supervisory body organises and oversees the entire process for authorising a deprivation of liberty  that occurs in a registered care home or hospital. (See Ordinary Residence chapter for more guidance on deciding ordinary residence where this is unclear).

Annex 1 in the DoLS Code of Practice provides an overview of the legal process that begins when an application for a standard authorisation is received.

As a first step, the managing authority (the hospital or registered care home) must fill out a Form 1 Deprivation of Liberty Safeguards: Resources – GOV.UK (www.gov.uk) requesting a standard authorisation. This should be sent to the supervisory body (the local authority), who will then decide whether the person meets the necessary requirements for a standard authorisation to be granted or not granted.

5.2 Managing authority granting an urgent authorisation

The managing authority must decide whether an urgent authorisation should be issued in addition to their application for a standard authorisation (this is their responsibility) or whether just a standard authorisation is needed.

An urgent authorisation enables the managing authority to lawfully deprive the relevant person of their liberty for a maximum of seven days where certain criteria are met. This can be extended by the Supervisory Body for a further seven days, but only if certain criteria are met (see Deprivation of Liberty Safeguards: Resources. DHSC).

When issuing an urgent authorisation, the managing authority must reasonably believe a standard authorisation would be granted.

Before granting an urgent authorisation, the managing authority should try to speak to the family, friends and carers of the person and inform the person managing the person’s care. Information they provide may assist in preventing the adult being deprived of their liberty. Efforts to contact family and friends and any discussions had with them should be documented in the adult’s case records and on the urgent authorisation. The managing authority also need to ensure that they provide up to date contact information of friends / family / carers / advocates / allocated worker and other professionals on the Form 1 when they make the referral or grant themselves an urgent authorisation.

6. The Assessment Process

Before the supervisory body can grant an authorisation for a deprivation of liberty, the following assessments will be completed:

  • mental health assessment: to confirm whether the person has an impairment / disturbance in the mind or brain;
  • eligibility assessment: to confirm the person’s existing or potential status under the Mental Health Act, and whether it would conflict with a DoLS authorisation (this would normally be in a hospital setting).
  • mental capacity assessment: carried out by either the mental health or best interest assessor to determine the person’s capacity to validly consent to their current care arrangements;
  • best interests assessment: confirms whether deprivation of liberty is occurring, whether it could be avoided, and whether it is in the person’s best interests. The assessment will also recommend, how long the authorisation should last and who should act as a person’s representative throughout the period of authorisation;
  • age assessment: to confirm the person is at least 18 years of age for DoLS. If a person is between the ages of 16 and 18 years of age, application needs to be made to the Court of Protection if they need to be deprived of their liberty;
  • no refusals assessment: to confirm whether there is any valid advance decision which would conflict with the authorisation, or a person with a valid and registered Lasting Power of Attorney with authority over welfare decisions.

The assessments must be completed by specially trained professionals.

An Independent Mental Capacity Advocate (IMCA) may also be appointed during the assessment process if required if the person does not have any family / friends or other non-professionals involved (see Independent Mental Capacity Advocates and Independent Mental Health Advocates chapter).

7. Granting, or not Granting, a Standard Authorisation

If any of the requirements in Section 6, The Assessment Process are not met, deprivation of liberty cannot be lawfully granted. This may mean the registered care home or hospital must change its care plan to remove the restrictions and restraints causing the deprivation of liberty.

If all requirements are fulfilled, the supervisory body must grant the deprivation of liberty authorisation, for up to a maximum of one year. The supervisory body must inform the adult, those consulted, and the managing authority in writing.

The restrictions should cease as soon as the adult no longer requires them; they do not have to be in place for the full period of the authorisation.

At the end of the authorisation period, if it is believed the adult still needs to be deprived of their liberty, the managing authority must request another authorisation.

8. Conditions and Recommendations

The best interests assessor can recommend certain conditions are applied to the standard authorisation. The supervisory body are responsible for issuing the recommended conditions if they agree with them or can issue ones of their own on the authorisation, which must be fulfilled by the managing authority.

It is ultimately the supervisory body’s responsibility that any conditions attached to a DoLS authorisation are complied with. The supervisory body should also send a monitoring form to the registered care home or hospital where a person is deprived of their liberty for them to feedback about conditions.

The best interests assessor or supervisory body can also give recommendations to the local authority or organisation managing a person’s care relating to the deprivation of liberty.

9. Appointing a Relevant Person’s Representative

Everyone who is subject to a deprivation of liberty standard authorisation will be appointed a Relevant Person’s Representative (RPR). They must maintain frequent face to face contact with the person, and represent and support them in all related matters, including requesting a review or applying to the Court of Protection to present a challenge to a DoLS authorisation.

If there is no family member, friend, or informal carer suitable to be the person’s representative, the DoLS office will appoint a paid representative. Their name should be recorded in the person’s health and social care records.

The RPR has the right to request the advice and support of a qualified IMCA (see Independent Mental Capacity Advocate and Independent Mental Health Advocate chapter).

In Re KT & others, which was heard before the Court of Protection, Mr Justice Charles approved the use of general visitors to act as Rule 3A (now Rule 1.2) Representatives when there is no one else – such as family members or advocates – available to act for the person who is the subject of the proceedings. General visitors are commissioned by the Court of Protection to visit the person and others involved in the case, and report back their findings. Appointing a general visitor safeguards the rights of the person in the proceedings.

It is also the responsibility of the Representative or Paid Representative to ensure that any conditions attached to a DoLS authorisation are complied with and report this back to the Court.

10. Reviewing the Standard Authorisation

This is also known as Part 8 DoLS Review. The registered care home / hospital (managing authority) must monitor and review the adult’s care needs on a regular basis and report any change in need or circumstances that would affect the deprivation of liberty authorisation or any attached conditions. The home / hospital must request a DoLS review if:

  • the adult (who is the ‘relevant person’) no longer meets any qualifying requirements;
  • the reasons they meet the qualifying requirements have changed;
  • it would be appropriate to add, amend or delete a condition placed on the authorisation due to a change in the adult’s situation;
  • the adult or their representative has requested a DoLS review, which they are entitled to do at any time.

The supervisory body where necessary, will arrange for assessors to carry out a review of an authorisation when statutory conditions are met. Statutory DoLS reviews do not replace other health or social care reviews.

A review of the DoLS requirements and or conditions can be undertaken, if necessary, at any time during an authorisation period.

10.1 Where the person ‘objects’ to being deprived of their liberty in a hospital or registered care home

Paragraph 4.45 of the DoLS Code of Practice highlights that ‘if the proposed authorisation relates to deprivation of liberty in a hospital wholly or partly for the treatment of a mental disorder, then the person (also known as the relevant person) will not be eligible for a deprivation of liberty if:

  • they object to being admitted to hospital, or to some or all the treatment they will receive there for mental disorder; and
  • they meet the criteria for an application for admission under section 2 or section 3 of the Mental Health Act 1983 (unless an attorney or deputy, acting within their powers, had consented to the things to which the person is objecting).

A judgement by Mr Justice Baker Royal Courts of Justice February 2015 ruled that in all cases where a person lacks capacity, a DoLS assessment has been completed and the person objects to their placement, a referral must be made to the Court of Protection under S.21A .

This referral would often be made by the Relevant Person’s Representative (RPR) (see Section 9,  Appointing a Relevant Person’s Representative) but if this does not happen the local authority should take action to make the referral themselves.

Practice lessons from the judgement include:

  • plan in advance: care should be taken to ensure that a DoLS assessment is completed prior to the move of the relevant person into residential accommodation. There should be very few exceptions to this rule. DoLS assessments should be completed in the case of ‘respite’ care if it is likely that this will become permanent either prior to the placement or with urgency after the placement is started;
  • RPR – conflict of interest: care should be taken that the person appointed as the RPR is willing to make a referral to the Court of Protection if the relevant person objects to their placement. This may be difficult if the RPR is a family member who has a personal interest in the placement of the relevant person. In this case a paid representative should be appointed;
  • local authority duty (supervisory body): the local authority has a duty to check that the RPR meets all the criteria and, if not, to take action to rectify this. They should make resources available to support IMCAs;
  • challenge to placement: where the relevant person is challenging their placement, action should be taken speedily to refer to Court of Protection.

Click here to view the judgement: AJ (Deprivation of Liberty Safeguards). 

11. Deprivation of Liberty outside a Hospital or Registered Care Home Setting

This is also known as deprivation of liberty in a domestic setting.

Applications to authorise a deprivation of liberty in the community are made to the Court of Protection (contact the local authority’s legal department for more details). In most cases the authorisation is a paper-based application that should not require a court hearing.

As a practitioner you will also need to ascertain whether the person who has a care package at home or in supported living, may be deprived of their liberty by way of their care plan – that is, do they meet the ‘acid test’ as described in Section 3, The Acid Test?

  • If, after consideration, the person meets the ‘acid test’, you will need to make the application for a deprivation of liberty which can only be authorised by the Court of Protection.
  • Let your manager know that you are working with a person who may be deprived of their liberty. This is important as all referrals to the Court of Protection need to be sent via the relevant legal team and there is a cost involved.
  • Follow the relevant guide from your legal department to make a deprivation of liberty application as soon as possible.
  • It is possible for more than one application to be made to the Court of Protection at a time and the court is currently able to accept numerous applications at the same time.
  • It is important that a person who has a Deprivation of Liberty authorisation in the community also has a Representative (COP Rule 1.2 part 3a); this person is appointed by the Court.

Court of Protection Hub Case Summaries – Court of Protection Hub

12. Alerting to Unlawful Deprivation of Liberty

If a person (professional or otherwise) suspects a person is being deprived of their liberty under the acid test (see Section 3, The Acid Test) and it has not been authorised, they should first discuss it with the registered care home/ hospital ward manager, domiciliary care or supported living manager.

If the manager agrees the care plan involves deprivation of liberty, they should be encouraged to make a request for authorisation. Everyone should be satisfied the care plan contains the least restrictive option available to keep the person safe, and that it is in the person’s best interest.

If the manager does not agree to make a request for a DoLS authorisation, the concerned person should approach the local authority or Court of Protection to discuss the situation and report the potential unlawful deprivation.

13. Consequences of an Unlawful Deprivation of Liberty

If an organisation breaches a person’s human rights (Articles 5 & 8) by unlawfully depriving them of their liberty, it could result in legal action being taken, including a court declaration that the organisation has acted unlawfully and breached the adult’s human rights. This could lead to a claim for compensation, negative press attention and remedial action taken by commissioners and regulators.

14. Patients Receiving Life Sustaining Treatment

See Intensive Care Society and the Faculty of Intensive Care Medicine Guidance on MCA / DoL

The judgement in R (Ferreira) v HM Senior Coroner for Inner South London held that patients in intensive care  are not necessarily deprived of their liberty as per the acid test in Cheshire West, as the facts in the two cases differ. The effect of this judgement is that even if a patient receiving ‘life sustaining treatment’ (S.4b MCA) appears to be deprived of their liberty, they will not be said to be so if the primary condition they are being treated for is a physical condition even if there is an underlying mental disorder and they are an inpatient in intensive care.

“There is in general no need in the case of physical illness for a person of unsound mind to have the benefit of safeguards against deprivation of liberty where the treatment is given in good faith and is materially the same treatment as would be given to a person of sound mind with the same physical illness.” (Judge Lady Justice Arden)

The Judge also held however that there may be some circumstances where a deprivation of liberty arises and needs to be authorised. In NHS Trust & Ors v FG [2015] for example, a hospital sought authorisation to deprive a pregnant woman of her liberty. The order prevented her from leaving the delivery suite and authorised invasive medical treatment such as a caesarean section.

Any treatment, therefore, for a primary condition which is a physical condition will not constitute a deprivation of liberty where the same treatment would be given to a patient who had capacity.

15. Guidance on Covert Medications and DoLS

Covert medication is an interference with an individual’s right to a private life (Article 8). It is also likely to contribute to someone being deprived of their liberty (Article 5). The decision to covertly medicate should therefore always be subject to close scrutiny, particularly if that medication will affect an individual’s behaviour, mental health or act as a sedative. It is essential that any covert medication is administered in the least restrictive way possible and that safeguards are in place, for example, regular reviews of the decision to covertly medicate and whether it remains the least restrictive option in that particular patient’s case.

The steps that should be followed are as follows:

  • if an individual lacks capacity, is refusing to take the medication and is unable to understand the risks to their health if they fail to take the medication, then, in exceptional circumstances, covert medication can be considered;
  • prior to medication being administered covertly, a best interests meeting should be held with the relevant healthcare professionals, Relevant Person’s Representative (RPR) (if appointed) and family members;
  • if there is no agreement, there should be an immediate application to Court;
  • if it is agreed by everyone that covert administration of medication is in the individuals best interests, then this must be recorded and placed in their medical and/or care home records;
  • the existence of the covert medication must be clearly identified within the best interests assessment and DOLS authorisation;
  • an agreed management plan must be adopted allowing for the decision to covertly medicate and the corresponding care and support plan to be reviewed;
  • the management plan should specify the timeframes (possibly monthly, where the standard authorisation is longer than six months) and circumstances (such as change of medication or treatment regime) which would trigger a review;
  • these reviews should involve the relevant healthcare professionals, RPR (if appointed) and family members;
  • all of this information must be easily accessible when reviewing any of the individual’s records.

Each case is fact specific. However, where covert medication was anticipated prior to the best interests’ assessment, it would be inappropriate for standard authorisation to be for the maximum period of authorisation.

This reinforces the NICE guidelines on Covert Medication Administration. It emphasises that, while covert medication may, on the face of it, appear not to be a particularly restrictive option, it may still be a breach of an individual’s rights if the appropriate safeguards are not adopted.

It is therefore essential that where covert medication is used in an individual’s treatment, it is always the least restrictive option and there are checks in place to ensure that this decision is regularly reviewed.

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1. Introduction

The Independent Mental Capacity Advocate (IMCA) was introduced by the Mental Capacity Act 2005 (MCA). The Act gives some people who lack capacity a right to receive support from an IMCA.

The local authority has a duty to make sure that IMCAs are available to represent people who lack capacity to make specific decisions, so staff will need to know when an IMCA must be involved (see Mental Capacity).

IMCAs are independent and generally work for advocacy providers who are not part of a local authority or the NHS.

2. Eligibility

2.1 Independent Mental Capacity Advocates

The majority of adults who access the IMCA service are people with learning disabilities, older people with dementia, people who have an acquired brain injury or people with mental health problems and / or are affected by drug or alcohol use.

IMCAs also act when people have a temporary lack of capacity because they are unconscious or barely conscious whether due to an accident, being under anaesthetic or as a result of other conditions.

A person’s capacity may vary over time or may depend on the type of decision that needs to be made.

Many adults have significant barriers to communication and are unable to instruct the advocate themselves. In addition, many people using the service will be unable to express a view about the proposed decision.

The IMCA service is provided for any person aged 16 years or older, who has no one able to support and represent them, and who lacks capacity to make a decision about either:

  • a long-term care move;
  • serious medical treatment;
  • safeguarding adult procedures; or
  • a care and support plan review.

Such a person will have a condition that is affecting their ability to make decisions.

IMCAs should be available to people who are in prison, in hostels or homeless and who lack capacity to make decisions about serious medical treatment or long term accommodation.

Many people who qualify for advocacy under the Care Act 2014 will also qualify for advocacy under the MCA. The same advocate can provide support as an advocate under the Care Act and under the MCA. This is to enable the person to receive seamless advocacy so that they don’t have to repeat their story. Whichever legislation the advocate is acting under, they should meet the appropriate requirements for an advocate under that legislation.

Both the Care Act and the MCA recognise the same areas of difficulty, and both require a person with these difficulties to be supported and represented, either by family or friends, or by an independent advocate or  independent mental capacity advocate in order to communicate their views, wishes and feelings.

2.2 Independent Mental Health Advocates

Under the Mental Health Act 1983 (MHA) people, known as ‘qualifying patients’, are entitled to the help and support from an Independent Mental Health Advocate (IMHA).

Independent advocacy under the duty flowing from the Care Act is similar in many ways to independent advocacy under the MCA. Regulations have been designed to enable independent advocates to be able to carry out both roles. For both:

  • the advocate’s role is to support and represent people;
  • the advocate’s role is primarily to work with people who do not have anyone appropriate to support and represent them;
  • the advocates require a similar skill set;
  • regulations about the appointment and training of advocates are similar;
  • local authorities are under a duty to consider representations made by both independent advocates and IMCA;
  • advocates will need to be well known and accessible;
  • advocates may challenge local authority decisions;
  • people who qualify for an IMCA in relation to the care planning and care review – as that planning may result in an eligible change of accommodation decision – will (in nearly all cases) also qualify for independent advocacy under the Care Act. The provisions of the Care Act are however wider and apply to care planning irrespective of whether it may result in a change of accommodation decision. People for whom there is a power to instruct an IMCA in relation to care review will (in nearly all cases) also qualify for independent advocacy under the Care Act. The Care Act however creates a duty rather than a power in relation to advocacy and care reviews.

3. The Care Act and the Mental Capacity Act

3.1 Advocacy duties under the Care Act

The duty to provide independent advocacy is to provide support to:

  • people who have capacity but who have substantial difficulty in being involved in the care and support ‘processes’;
  • people in relation to their assessment and / or care and support planning regardless of whether a change of accommodation is being considered for the person;
  • people in relation to the review of a care and / or support plan;
  • people in relation to safeguarding processes (though IMCAs may be involved if the authority has exercised its discretionary power under the MCA and appointed an IMCA if protective measures are being proposed for a person who lacks capacity, at the time to make the relevant decisions or understand their consequences);
  • carers who have substantial difficulty in engaging, whether or not they have capacity;
  • people for whom there is someone who is appropriate to consult for the purpose of best interests decisions under the Mental Capacity Act, but who is not able and / or willing to facilitate the person’s involvement in the local authority process;
  • adults who are subject to a safeguarding enquiry or safeguarding adult review

3.2 Care Act and Mental Capacity Act

A person may be entitled to an advocate under the Care Act and then, as the process continues it may be identified that there is a duty to provide an advocate (IMCA) under the MCA. This will occur for example when during the process of assessment or care and support planning it is identified that a decision needs to be taken about the person’s long term accommodation. It would be unhelpful to the individual and to the local authority for a new advocate to be appointed at that stage.

It would be better that the advocate who is appointed in the first instance is qualified to act under the MCA (as IMCAs) and the Care Act and that the commissioning arrangements enable this to occur.

4. Role of the IMCA

The IMCA should go to meetings on the adult’s behalf and examine proposed decisions to make sure that:

  • all options have been considered;
  • where the adult’s own preferences and dislikes can be identified, these are taken into account;
  • no particular agendas are being pursued; and
  • the person’s civil, human and welfare rights are being respected.

The IMCA is not best interests advocacy. The IMCA should not offer their own opinion or make the decision.

They should be experienced at working with people who have difficulties with communication. They should always attempt to get to know the adult’s preferred method of communication and spends time finding out if a person is able to express a view and how they communicate.

5. Safeguarding Adult Cases and Care and Support Plan Reviews

When people meet the IMCA criteria, the local authority and the NHS have a duty to instruct an IMCA for changes in accommodation and serious medical treatment decisions.

For safeguarding adult cases and care and support plan reviews, the local authority and the NHS have powers to appoint an IMCA where they consider the appointment would be of particular benefit to the person concerned.

Local authorities in England should have a policy on how IMCAs will be involved in care and support plan reviews and safeguarding adult procedures.

The local authority and the NHS have powers to instruct an IMCA to support and represent a person who lacks capacity where:

  • it is alleged the person is or has been abused or neglected by another person; or
  • it is alleged the person is abusing or has abused another person

A responsible body can instruct an IMCA to support and represent a person who lacks capacity when:

  • they have arranged accommodation for that person;
  • they aim to review the arrangements (as part of a care plan or otherwise); or
  • there are no family or friends whom it would be appropriate to consult.

6. Referrals and the Referral Process

Any adult who meets the following criteria must be referred to the IMCA service.

  • Is a decision being made about serious medical treatment or a change of accommodation; or a care and support plan review or safeguarding adult procedures?
  • Does the person lack capacity to make this particular decision?
  • Is the person over 16 years old?
  • Is there nobody (other than paid staff providing care or professionals) whom the decision maker considers willing and able to be consulted about the decision? (This does not apply to safeguarding adult cases.)

NHS bodies must instruct and take into account information from an IMCA where decisions are proposed about serious medical treatment, where the person lacks capacity to make the decision and there are no family or friends who are willing and able to support the person.

Serious medical treatment involves:

  • giving new treatment;
  • stopping treatment that has already started; or
  • withholding treatment that could be offered; and where there is either:
    1. a fine balance between the benefits and the burdens and risks of a single treatment;
    2. choice of treatments which are finely balanced; or
    3. what is proposed would be likely to involve serious consequences.

A person has a right to an IMCA if such treatment is being contemplated on their behalf and the person has been assessed as lacking capacity to make the decision for themselves at that time.

An IMCA cannot be involved if the proposed treatment is for a mental disorder and that treatment is authorised under Part 1V of the Mental Health Act 1983. However, if a person is being treated under the MHA and the proposed treatment is for a physical illness, for example, cancer, an IMCA can be involved

Local authority and NHS staff must be able to identify when a person has a right to an IMCA and know how to instruct an IMCA.

Firstly, they should know which organisation has been commissioned to provide an IMCA service in the local authority. Local arrangements will be in place with each IMCA service provider regarding the ways in which referrals can be made.

At the time when the referral is made it must be evident that:

  • a person lacks the capacity to make the particular decision;
  • the decision is either serious medical treatment; a change in accommodation, a care review or an adult protection case; and
  • there is nobody who can appropriately support and represent the person (this does not apply to safeguarding adults).

7. When an IMCA cannot be involved

An IMCA cannot be involved if:

  • a person has capacity;
  • the proposed serious medical treatment is authorised under the MHA and is therefore for a mental disorder rather than a physical condition;
  • the proposed long term change in accommodation is a requirement under the MHA;
  • there is no identifiable decision about a long term change in accommodation or serious medical treatment or decisions relating to a care and support plan review or safeguarding adult procedures;
  • there is any other person (not in a paid capacity) who is willing and able to support and represent appropriately the person who lacks capacity; or
  • decisions are being made in relation to a person’s finances, unless there are safeguarding adult procedures in which an IMCA is involved.

The IMCA will stop being involved in a case once the decision has been finalised and they are aware that the proposed action has been carried out. They will not be able to provide ongoing advocacy support to the person. If it is felt that a person needs advocacy support after the IMCA has withdrawn, it may be necessary to make a referral to a local advocacy organisation (see Independent Advocacy).

8. Person requiring an IMCA is Receiving Funding from outside the Area where they are currently Living

Each IMCA service covers a local authority area and all eligible people in that area, whether on a permanent or temporary basis, must be referred to the local IMCA service.

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RELEVANT CHAPTER

Mental Capacity

1. Introduction

The Care and Support Statutory Guidance advises that the first priority in safeguarding should always be to ensure the safety and wellbeing of the adult.

Making Safeguarding Personal is a person centred approach which means that adults are encouraged to make their own decisions and are provided with support and information to empower them to do so. This approach recognises that adults have a general right to independence, choice and self-determination including control over information about themselves. Staff should strive to deliver effective safeguarding consistently with both of the above principles. They should ensure that the adult has accessible information so that the adult can make informed choices about safeguarding: what it means, risks and benefits and possible consequences. Staff will need to clearly define the various options to help support them to make a decision about their safety.

2. Giving Consent

Adults may not give their consent to the sharing of safeguarding information for a number of reasons. For example, they may be unduly influenced, coerced or intimidated by another person, they may be frightened of reprisals, they may fear losing control, they may not trust social services or other partners or they may fear that their relationship with the abuser will be damaged. Reassurance and appropriate support may help to change their view on whether it is best to share information. Staff should consider the following and:

  • explore the reasons for the adult’s objections – what are they worried about?
  • explain the concern and why you think it is important to share the information;
  • tell the adult with whom you may be sharing the information with and why;
  • explain the benefits, to them or others, of sharing information – could they access better help and support?
  • discuss the consequences of not sharing the information – could someone come to harm?
  • reassure them that the information will not be shared with anyone who does not need to know;
  • reassure them that they are not alone and that support is available to them.

3. Overriding Refusal to give Consent

If, after this, the adult refuses intervention to support them with a safeguarding concern, or requests that information about them is not shared with other safeguarding partners, in general, their wishes should be respected. However, there are a number of circumstances where staff can reasonably override such a decision, including:

  • the person is unable to understand relevant information; retain the information; make a decision based on the information given;
  • unable to communicate a choice on the matter because he / she is unconscious;
  • emergency or life threatening situations may warrant the sharing of relevant information with the emergency services without consent;
  • other people are, or may be, at risk, including children;
  • sharing the information could prevent a serious crime;
  • a serious crime has been committed;
  • the risk is unreasonably high and meets the criteria for a multi-agency risk assessment conference referral (see Multi-Agency Risk Assessment Conference chapter);
  • staff are implicated;
  • there is a court order or other legal authority for taking action without consent.

In such circumstances, it is important to keep a careful record of the decision making process. Staff should seek advice from managers in line with their organisation’s policy before overriding the adult’s decision, except in emergency situations. Managers should make decisions based on whether there is an overriding reason which makes it necessary to take action without consent and whether doing so is proportionate because there is no less intrusive way of ensuring safety. Legal advice should be sought where appropriate. If the decision is to take action without the adult’s consent, then unless it is unsafe to do so, the adult should be informed that this is being done and of the reasons why.  This is particularly important in light of the new legal right patients now have to know why their health information is being shared without their consent.

4. Supporting the Adult

If none of the above apply and the decision is not to share safeguarding information with other safeguarding partners, or not to intervene to safeguard the adult:

  • support the adult to weigh up the risks and benefits of different options;
  • ensure they are aware of the level of risk and possible outcomes;
  • offer to arrange for them to have an advocate or peer supporter;
  • offer support for them to build confidence and self-esteem if necessary;
  • agree on and record the level of risk the adult is taking;
  • record the reasons for not intervening or sharing information;
  • regularly review the situation;
  • try to build trust to enable the adult to better protect themselves.

5. Considering Risk

It is important that the risk of sharing information is also considered. In some cases, such as domestic abuse or hate crime, it is possible that sharing information could increase the risk to the adult. Safeguarding partners need to work jointly to provide advice, support and protection to the adult in order to minimise the possibility of worsening the relationship or triggering retribution from the abuser.

6. Consent and Mental Capacity

Correctly applying the Mental Capacity Act 2005 (MCA) is pivotal in safeguarding work when an adult lacks mental capacity. Good practice maximises an adult’s ability to understand and participate in the decision making process. If the adult is assessed as lacking mental capacity, best interest decisions should be made on their behalf (see Best Interests chapter).

All adults must be helped and supported to make a decision independently before a mental capacity assessment is conducted. This includes gaining consent in relation to undertaking safeguarding enquiries. If an adult is deemed as lacking mental capacity, they may still be able to participate in making decisions. Some decisions are excluded decisions under the MCA, that is they cannot be made on the person’s behalf (see Section 3, Excluded Decisions, Mental Capacity chapter).

The following points may need to be considered in these discussions. It aims to help practitioners to structure their thoughts and make judgements to help them produce well informed, person centred assessments, conclusions and best interest decisions. It is not a prescriptive or exhaustive list and each case will present its own unique opportunities and challenges.

The range and type of decisions that an adult, or their advocate, needs to make in safeguarding cases include:

  • consent to starting the process;
  • consent to sharing information;
  • consent to safeguarding enquiries proceeding;
  • consent to protective measures being discussed and planned.

These decisions regarding consent involve the adult demonstrating an understanding of:

  • what harm has occurred;
  • the risks and consequences of the harm;
  • specific protective measures and what they entail.

This may involve conversations with adults which are of a sensitive, personal and often difficult nature. The guidance below provides points that may need to be considered in these discussions. It aims to help practitioners to structure their thoughts and make judgements which help them produce well-informed, person centred assessment conclusions and best interest decisions. It is not a prescriptive or exhaustive list and each case will present its own unique opportunities and challenges.

Practitioners must be aware that consent may not be needed when it:

  • will increase the risk of harm to the person or others;
  • threatens the person’s or others safety (for example serious injury, risk to life);
  • threatens the public interest (for example where people who work with adults with care and support needs or children are implicated in wrongdoing).

7. Consent to Information Sharing

See also South Tyneside Multi Agency Information Sharing Agreement

There will be times when an adult who has mental capacity decides to accept a situation considered as harmful or neglectful. Where this is the situation and they do not want any action to be taken, this does not preclude the sharing of information with relevant professional colleagues. This is to enable professionals to assess the risk of harm and be confident that the adult is not being unduly influenced, coerced or intimidated and is aware of all the options. This will also enable professionals to check the safety and validity of decisions made. Practitioners should seek consent of the adult to share the information, unless doing so would increase the risk of harm. Whilst a capacitated adult is free to make an unwise or bad decision, the local authority and / or the police can take steps to protect them if they are at risk of abuse if they are being unduly influenced, coerced or intimidated.

Information can be shared with other professionals, without the adult’s consent, if the following apply:

  • other people are being put at risk (for example, letting friends who are abusive or exploitative into a shared living environment, where they may put other residents at risk);
  • a child is involved;
  • the alleged person causing harm has care and support needs and may also be at risk;
  • a crime has been committed;
  • staff are implicated.

8. Consent to Treatment

See also Reference Guide to Consent for Examination or Treatment (Department of Health and Social Care)

It is a general legal and ethical principle that valid consent must be obtained before starting treatment, physical investigation or providing personal care for an adult. This principle reflects their right to determine what happens to their own bodies, and is a fundamental part of good practice.

A healthcare professional (or other staff) who does not respect this principle may be liable both to legal action by the adult and to action by their professional body. Employing bodies may also be liable for the actions of their staff.

Whilst there is no English statute setting out the general principles of consent, case law (known also as ‘common law’) has established that touching a patient without valid consent may constitute the civil or criminal offence of battery. Further, if healthcare professionals (or other staff) fail to obtain proper consent and the patient subsequently suffers harm as a result of treatment, this may be a factor in a claim of negligence against the healthcare professional involved.

Poor handling of the consent process may also result in complaints from patients through the NHS complaints procedure or to professional bodies.

Where a person lacks the capacity to make a decision for themselves, any decision must be made in that person’s best interests (see Best Interests). Certain serious medical treatment cases such as withdrawing artificial hydration or nutrition, or the non-therapeutic sterilisation of a person who lacks capacity for contraceptive purposes must be referred to the Court of Protection.

The MCA introduced a duty on NHS bodies to instruct an independent mental capacity advocate (IMCA) in relation to decisions regarding serious medical treatment, when an adult lacks the capacity to make a decision has no one who can speak for them, other than paid staff.

The MCA allows people to plan ahead for a time when they may not have the capacity to make their own decisions: it allows them to appoint a personal welfare attorney to make health and social care decisions, including medical treatment, on their behalf or to make an advance decision to refuse medical treatment.

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RELEVANT CHAPTER

Best Interests

Independent Mental Capacity Advocates and Independent Mental Health Advocates

SOUTH TYNESIDE RELEVANT INFORMATION

Deprivation of Liberty Safeguards (DoLS): Policy and procedure document to support the implementation of the DoLS process in South Tyneside

Multi Agency Information Sharing Agreement

See also Forms, Leaflets and Posters for local forms

OTHER RELEVANT INFORMATION

Mental Capacity Act 2005 at a Glance, SCIE

Mental Capacity Act (MCA): e-Learning course (SCIE)

Mental Capacity Toolkit (Bournemouth University and Burdett Nursing Trust)

November 2023: A new section 4.2 has been added explaining the causative nexus, which seeks to ensure than when a person is assessed as being able unable to make a decision under the Mental Capacity Act, this is because of their impairment of, or a disturbance in the functioning of, their mind or brain.

1. Introduction

The Mental Capacity Act 2005 (MCA) provides a statutory framework to empower and protect people who may lack mental capacity to make decisions for themselves, and establishes a framework for making decisions on their behalf. This applies whether the decisions are life changing events or everyday matters.

Whenever the term ‘a person who lacks capacity’ is used, it means a person who lacks mental capacity to make a particular decision or take a particular action for themselves at the time the decision or action needs to be taken. This reflects the fact that people may lack mental capacity to make some decisions for themselves, but will have mental capacity to make other decisions. For example, they may have mental capacity to make small decisions about everyday issues such as what to wear or what to eat, but lack mental capacity to make more complex decisions about financial matters.

It also reflects the fact that a person who lacks mental capacity to make a decision for themselves at a certain time may be able to make that decision at a later date. This may be because they have an illness or condition that means their capacity changes. Alternatively, it may be because, at the time the decision needs to be made, they are unconscious or barely conscious (for example because of an accident or being under anaesthetic or that their ability to make a decision may be affected by the influence of alcohol or drugs).

Finally, it reflects the fact that while some people may always lack mental capacity to make some types of decisions – for example, due to a condition or severe learning disability that has affected them from birth – others may learn new skills that enable them to gain capacity and make decisions for themselves’ (Mental Capacity Act: Code of Practice).

The MCA legislates in relation to:

  • allowing adults to make as many decisions as they can for themselves;
  • enabling adults to make advance decisions about whether they would like future medical treatment;
  • allowing adults to appoint, in advance of losing mental capacity, another person to make decisions about health and welfare or finance and property on their behalf at a future date;
  • allowing decisions concerning health and welfare or property and finance to be made in the best interests of adults when they have not made any future plans and cannot make a decision at the time;
  • ensuring an NHS body or local authority appoints an independent mental capacity advocate to support a person who cannot make a decision about serious medical treatment, or about hospital, care home or residential accommodation, when there are no family or friends who can be consulted (see Independent Mental Capacity Advocates and Independent Mental Health Advocates chapter);
  • providing protection against legal responsibility for carers who have honestly and reasonably seek to act in the person’s best interests;
  • providing clarity and safeguards around research in relation to those who lack capacity.

All decisions taken in the adult safeguarding process must comply with the MCA. It is always important to establish the mental capacity of an adult who is at risk of abuse or neglect, should there be concerns over their ability to give informed consent to:

  • planned interventions and decisions about their safety;
  • their safeguarding plan and how risks are to be managed to prevent future harm.

The MCA relates to people over the age of 16 years old. However, these SAB policies and procedures apply only to adults over the age of 18 years.

2. Principles of the Mental Capacity Act

Under the MCA, the following five principles apply:

  1. It must be assumed that a person has mental capacity to make their own decisions, unless they have been assessed as lacking mental capacity.
  2. A person should not be treated as unable to make a decision unless all practical steps to help them do so have been taken without success.
  3. A person should not be treated as unable to make a decision just because they make a decision that seems to others to be unwise or bad.
  4. An act done or decision made on behalf of a person who lacks mental capacity must be done, or made, in their best interests.
  5. Before an act is done, or a decision is made, staff must consider whether its intended purpose can be achieved in a way that is less restrictive of the person’s rights and freedom of action.

These five principles should inform all actions when working with a person who may lack or have reduced mental capacity and should be evidenced when making decisions on their behalf.

3. Assessing Capacity

It must always be assumed that an adult has the mental capacity to make their own decisions unless it is established that they lack the capacity to do so. This means that anybody who claims an adult lacks mental capacity should be able to provide evidence in support of this.

They need to demonstrate, on the balance of probabilities, that the adult lacks the mental capacity to make a particular decision, at the time it needs to be made. This means being able to demonstrate it is more likely than not that the person lacks capacity to make the decision in question.

3.1 Two Stage Test

To help assess if a person lacks mental capacity, the MCA sets out a two stage test:

Stage 1: The Functional Test – can the adult make the decision in question?

This test looks at whether the adult is able to make the required decision.

Practical and appropriate support should be provided to help the adult make the decision for themselves if required.

An adult is considered unable to make a decision if they cannot:

  1. understand information about the decision to be made (known as the ‘relevant information’);
  2. keep that information in their mind;
  3. use or weigh up that information as part of the decision making process; or
  4. communicate their decision (by talking, using sign language or any other means).

There only needs to be evidence in one of these areas, not all of them.

If the adult cannot make the decision in question – even with support – Stage 2 must then be considered.

Stage 2: The Diagnostic Test – is the adult unable to make the decision because of an impairment of, or a disturbance in, the functioning of their mind or brain?

This requires evidence to show the person has an impairment or disturbance of the mind or brain. Examples include:

  • conditions associated with some types of mental illness;
  • dementia;
  • significant learning disabilities;
  • the long-term effects of brain damage;
  • physical or medical conditions that cause confusion, drowsiness or loss of consciousness;
  • delirium;
  • concussion following a head injury; and
  • symptoms of alcohol or drug use.

If a person does not have such an impairment or disturbance of the mind or brain, they will not lack mental capacity under the MCA.

Once the adult has been identified as having an impairment or disturbance in the functioning of the mind or brain, it is important to check that their inability to make the decision is because of this impairment. This is known as the ‘causative nexus’ (PC and NC v City of York Council [2013] EWCA Civ 478). Only where it can be reasonably said that the person cannot make the decision because of the impairment of their mind, can it be said that they lack mental capacity to make the decision.

4. Safeguarding and Mental Capacity

During a safeguarding enquiry, important decisions will have to be made throughout the process. It is therefore vital that – where an adult does not have mental capacity – decisions made or action taken on their behalf are in their best interests.

An assessment of an adult’s mental capacity should be considered in all safeguarding cases where:

  • there is a formal diagnosis of cognitive impairment;
  • a neuro-psychological assessment testing suggests they have cognitive impairment;
  • concerns about the person’s mental capacity that have been raised by others;
  • there are discrepancies in the person’s own evaluation of their abilities;
  • there is collateral evidence suggesting a change in their personality;
  • they fail to learn from their mistakes;
  • they repeatedly make risky or unwise decisions.

5. Recording

The two stage test should be used as a framework for recording the assessment of mental capacity, so that the evidence for decision making is clear.

Recording needs to be clear and, where possible, extracts taken from conversations practitioners have had with the adult, to evidence the outcome.

6. Making Decisions on behalf of Someone who Lacks Mental Capacity

If, having taken all practical steps to support the adult to make their own decision, it is decided that a decision should be made for them, that decision must then be made in their best interests (See Section 8, Best Interests)

It is important to also consider whether there is another way of making the decision which might not affect the person’s rights and freedom of action as much (known as the ‘least restrictive alternative’ principle).

See also Promoting Less Restrictive Practice: Reducing Restrictions Tool for Practitioners (ADASS and LGA) 

6.1 Decision makers

Different people can make decisions or act on behalf of someone who lacks mental capacity. The person making the decision is known as the ‘decision maker’, and it is their responsibility to decide what would be in the best interests of the person who lacks mental capacity.

For most day to day actions or decisions, the decision maker will be the carer most directly involved with the person at the time.

Where the decision involves the provision of medical treatment, the professional proposing the treatment is the decision maker.

Where nursing or paid care is provided, the nurse or paid carer will be the decision maker.

In safeguarding cases, the practitioner who is undertaking the enquiry will be the decision maker for decisions relating to the safeguarding process.

In some cases, the same person may make different types of decision for someone who lacks mental capacity. For example, a carer may carry out certain acts in caring for the person on a daily basis, but if they are also an attorney, appointed under a Lasting Power of Attorney (LPA), they may also make specific decisions concerning the person’s property and financial affairs or health and welfare.

A decision may also, at times, be made jointly by a number of people. For example, when a care plan for a person who lacks capacity is being developed, different health or social care staff might be involved in making decisions or recommendations about their care package. Alternatively, the decision may be made by one practitioner within the team. A different member of the team may then implement that decision, based on what the team has ascertained to be the person’s best interests. Practitioners need to ensure that someone is representing the adult, such as an independent mental capacity advocate (IMCA) or a relevant person’s representative (RPR).

All best interests decisions under the MCA should be made by consensus.  If the parties cannot agree then steps should be taken to resolve the disagreement, e.g. re-assessing the person’s needs.  If agreement cannot be reached then any public bodies involved will need to consider whether to apply to the Court of Protection.

6.2 Lasting powers of attorney, court appointed deputy and the Office of the Public Guardian

A lasting power of attorney (LPA) allows an adult to appoint someone who will act on their behalf if they lose mental capacity in the future. LPAs are registered with the Office of the Public Guardian (OPG).

A court appointed aeputy is appointed by the Court of Protection. Depending on the terms of their appointment, deputies can take decisions on welfare, healthcare and financial matters as authorised by the Court of Protection but they are not able to refuse consent to life sustaining treatment. Deputies are only appointed if the Court cannot make a one off decision to resolve the issues. The OPG supervises deputies appointed by the Court and provides information to help the Court make decisions.

Attorneys and deputies are legal representatives. They can be a member of the person’s family or a friend; it does not have to be a legal professional.

6.3 Independent mental capacity advocates

See also Independent Mental Capacity Advocates and Independent Mental Health Advocates chapter.

Independent mental capacity advocates (IMCA) are appointed to support a person who lacks mental capacity and has no one to speak for them. IMCAs have to be involved where decisions are being made about serious medical treatment or a change in the adult’s accommodation where it is provided, or arranged, by the NHS or a local authority. The IMCA represents the person’s wishes, feelings, beliefs and values, and brings all relevant factors to the attention of the decision maker. IMCA services are provided by organisations that are independent of the NHS and local authorities.

6.4 Forward planning

Considering the possibility of losing mental capacity and registering Lasting Power of Attorneys is usually associated with people getting older, but it can be useful for adults of any age to think about making use of such provisions, in case of unexpected illnesses or accidents for example, that results in a temporary or permanent loss of mental capacity.

Using an LPA is not limited to circumstances where an adult’s mental capacity is reduced. For example, if a person (the donor) has an illness which means they can’t leave the house, has registered an LPA in relation to property and financial affairs, the attorney can carry out financial transactions on their behalf and with their permission.

Although an LPA cannot be used until it has been fully registered with the OPG and confirmation received, they can be registered before the adult loses mental capacity, which means that they could be used immediately if required.

7. Best Interests

See also Best Interests chapter.

The MCA sets out a checklist of things to consider when deciding when making decisions in a person’s best interests. When making best interests decisions, practitioners should:

  • not make assumptions about an adult based on age, appearance, condition or behaviour;
  • consider all the relevant circumstances;
  • consider whether the person has (or will have) mental capacity to make the decision;
  • support the person’s participation in any acts or decisions made for them;
  • not make decisions about life sustaining treatment which are motivated by a desire to bring about the person’s death;
  • consider the person’s expressed wishes and feelings, beliefs and values;
  • take into account the views of others with an interest in the person’s welfare, their carers and those appointed to act on their behalf.

8. Excluded Decisions

There are certain decisions which can never be made on behalf of a person who lacks mental capacity. This is because they are either so personal to the individual concerned, or they are governed by other legislation.

8.1 Decisions concerning family relationships

Nothing in the MCA allows a decision to be made on someone else’s behalf in relation to:

  • consenting to marriage or a civil partnership;
  • consenting to have sexual relations;
  • consenting to a decree of divorce on the basis of two years’ separation;
  • consenting to the dissolution of a civil partnership;
  • consenting to a child being placed for adoption or the making of an adoption order;
  • discharging parental responsibility for a child in matters not relating to the child’s property;
  • contact with others, including restricting the use of social media, telephone calls and who can visit the adult; or
  • giving consent under the Human Fertilisation and Embryology Act 1990.
  • media, telephone calls and who can visit the adult.

All these types of decisions should be referred to the Court of Protection if the person is believed to lack mental capacity to make these decisions themselves.

8.2 Mental Health Act matters

Where a person who lacks mental capacity to consent is currently detained and being treated under the Mental Health Act 1983, nothing in the MCA authorises anyone to:

  • give the person treatment for mental disorder; or
  • consent to them being given treatment for mental disorder.

8.3 Voting rights

Nothing allows a decision on voting – at an election for any public office or at a referendum – to be made on behalf of a person who lacks capacity to vote.

8.4 Unlawful killing or assisting suicide

Nothing in the MCA affects the law relating to murder, manslaughter or assisting suicide.

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RELEVANT CHAPTERS

Safeguarding: What is it and Why does it Matter?

SOUTH TYNESIDE SPECIFIC GUIDANCE

South Tyneside Safeguarding Adult Review Protocol (opens in Word)

See also Local Forms, Leaflets and Posters for Safeguarding Adult Review Referral Form

June 2024: The South Tyneside Safeguarding Adult Review (SAR) Protocol has replaced with an updated version.

1. Introduction

The Care Act 2014 states that Safeguarding Adult Boards (SABs) must arrange a Safeguarding Adults Review (SAR) when:

  • an adult in its area with care and support needs dies as a result of abuse or neglect;
  • whether known or suspected; and
  • there is concern that partner agencies could have worked more effectively to protect the adult.

SABs must also arrange a SAR if an adult with care and support needs, in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect.

In the context of SARs, something can be considered serious abuse or neglect where, for example the individual was likely to have died but for an intervention, or suffered permanent harm or has reduced mental capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect.

SABs may arrange for a SAR in any other situations involving an adult in its area with care and support needs, whether or not they are being met by the local authority. The SAB may also commission a SAR in other circumstances where it feels it would be useful, including learning from ‘near misses’ and situations where the arrangements worked especially well. The SAB decides when a SAR is necessary, arranges for its conduct and if it so decides, implements the findings.

2. Criteria

The criteria are met when:

  • an adult dies (including death by suicide) and abuse or neglect is known or suspected to be a factor in their death; or
  • an adult has sustained a potentially life threatening injury through abuse, neglect, serious sexual abuse or sustained serious and permanent impairment of health or development through abuse or neglect; and one of the following:
  • where procedures may have failed and the case gives rise to serious concerns about the way in which local professionals and / or services worked together to safeguard adults;
  • serious or apparently systematic abuse that takes place in an institution or when multiple abusers are involved. Such reviews are likely to be more complex, on a larger scale and may require more time;
  • where circumstances give rise to serious public concern or adverse media interest in relation to an adult.

There is an expectation that individuals, agencies and organisations, cooperate with the review.. However,t the Act also gives the Safeguarding Adults Board (SAB) the power to require information from relevant parties. The SAB may also commission a SAR in other circumstances where it feels this would be useful, including learning from ‘near misses’ and situations where the arrangements worked especially well. The SAB will decide when a SAR is necessary, arrange for its conduct and if it so decides, implement the findings.

3. Criminal Investigations and Police Involvement

Where there is an ongoing criminal investigation or criminal proceedings, the SAB will need to consider, in consultation with the police, whether continuing with the SAR might prejudice their outcome and whether the completion of the SAR should be postponed until after the criminal investigation or proceedings have been completed.

4. Outside of a SAR Remit

Where the Safeguarding Adult Board agrees that a situation does not meet the criteria but agencies will benefit from a review of actions other methodologies may be considered. These include:

  • Serious Incident Review: organisations should use their own serious incident procedures if this is deemed suitable and special consideration should be given to the involvement of relevant partner organisation;.
  • Management review: a review by an individual organisation in relation to their understanding and management of a particular safeguarding issue;
  • Reflective Practice Session: The original participants in the case may review identified aspects of the case as part a reflective practice session chaired by the safeguarding lead or other relevant person, including an independent facilitator;
  • Learning Together SCIE: which is a collaborative scrutiny approach to a case review.

5. Principles

SARs will reflect the six adult safeguarding principles and be conducted within a framework of openness and transparency (see Context, Principles and Values chapter, Principles of Adult Safeguarding).

6. Purpose

The purpose of all SARs is to keep the focus on learning. The final SAR report and those responsible for disseminating the learning from it, should ensure that the recommendations can be translated into practice, not just for those involved but to a wider audience to support prevention strategies and influence strategic plans.

It is not for a SAR to investigate how a death or serious incident happened. Neither is it the responsibility of the SAR to apportion blame. Such matters will be dealt with by the Coroner’s or criminal courts, or other bodies.

7. The Adult

In non-fatal cases, the views of the adult should be central to the decision making process about the type of SAR to undertake. Communication should be established at the earliest opportunity and advocacy provided to support the adult. Information should be given about how the SAR will be conducted and how they can be involved or, in the event that the adult has deceased, how nominated people can be involved.

Where there is a police led investigation, close contact with any appointed police Family Liaison Officer should be made. Communication should be clear and consistent between all designated supporters including independent advocates. See Section 3, Criminal Investigations and Police Involvement above in relation to cases where there is an ongoing criminal investigation or criminal proceedings.

8. Person alleged to have caused harm

The emphasis on learning should include the person alleged to have caused abuse or neglect so they can adjust their behaviour, act differently and reflect upon the impact that they might have had on others. This may involve liaison with other professionals, working with, or trained to work with people who abuse.

9. Advocacy

The local authority must arrange, where necessary, for an independent advocate to support and represent an adult who is the subject of a SAR. Where the adult is deceased, it is good practice to provide advocacy to family / friends.

10. Carers

The desired outcome, especially where a family is bereaved, needs to be approached with sensitivity. Consultation and involvement needs to be balanced with the overall wellbeing of the individuals involved. Throughout the process due diligence, compassion and appropriate support should be provided and the relevant local authority community team should be available to provide this or an alternative arranged if more appropriate.

11. Staff

All professionals should be fully involved in reviews and invited to contribute their perspectives without fear of being blamed for actions they took in good faith. Where an adult has died, professionals working with that adult should have the opportunity to discuss their feelings in a safe environment and offered counselling or other therapeutic support. Professional supervision may not be the most helpful means of exploring any fears or anxieties or coping mechanisms to enable professionals to take an objective view and learn from the SAR. There will be occasions when allegations are made that staff have been guilty of abuse against adults.

If the staff member is subject to a criminal investigation, consideration will need to be given to the timing of any SAR (see Section 3, Criminal Investigations and Police Involvement).

If the staff member is subject to a disciplinary enquiry, it is likely that the SAR will work alongside the disciplinary enquiry.

12. Who should undertake a SAR?

The individual commissioned to undertake the SAR should be independent of the organisations involved. They should have the appropriate core skills including:

  • strong leadership and ability to motivate others;
  • expert facilitation skills and ability to handle multiple perspectives and potentially sensitive and complex group dynamics;
  • collaborative problem solving experience and knowledge of participative approaches;
  • ability to find and evaluate best practice;
  • good analytic skills and ability to manage quantitative and qualitative data;
  • knowledge of safeguarding adults;
  • ability to write for a wide audience and
  • an understanding of the complexity of the health and social care system .

13. Requests

Any individual, agency or professional can request a SAR. This should be made in writing to the Chair of the Safeguarding Adults Board using the agreed referral form contained in Referral Form for a Safeguarding Adult Review. The following information should be included:

  • what happened – with dates if known;
  • the views of the adult / family / carer;
  • where the incident / concerns took place;
  • who was involved and their organisation and
  • why the request is being made.

The SAR subgroup will consider the request against the criteria in the Care Act in order to ensure the SAR process is consistently applied. Agreement to carry out a SAR should be recorded on relevant systems across the statutory agencies.

14. Commissioning a SAR

The Safeguarding Adults Board is the only body authorised to commission a SAR and decide when a SAR is necessary; arrange for its conduct and if it so decides, to oversee implementation of the findings.

The Safeguarding Adults Board will convene a subgroup to act on its behalf to receive and manage requests, and have delegated commissioning responsibilities. In commissioning a SAR the agreed protocol will be followed (see .South Tyneside Safeguarding Adult Review (SAR) Protocol). 

Whatever arrangements are in place, where there is agreement for a SAR, a SAR chair will be identified to co-ordinate arrangements.

14.1 SAR options

A number of options may be considered by the Safeguarding Adults Board or delegated subgroup. The approach used for the SAR be the most appropriate and proportionate model for the situation. No one model will be applicable for all cases. The focus must be on what needs to happen to achieve understanding, take remedial action and, very often, provide answers for families and friends of adults who have died or been seriously abused or neglected. Every effort should be made while the SAR is in progress to capture points from the case about improvements needed and to take corrective action.

When commissioning a SAR the following points will be agreed:

  • scope of the terms of reference;
  • knowledge, skills and experience of the reviewer;
  • timescales for completion;
  • who will secure any legal advice required;
  • how the interface between the SAR and any other investigations or reviews will be managed;
  • a communication strategy, including clarification about what information can be shared, when and where (conditions);
  • a media strategy;
  • what the arrangements for administrative and professional support are and
  • how it will be paid for.

15. Links with other Reviews and Investigations

For victims of domestic homicide, there is separate statutory guidance in respect of children, which provides for a  Child Safeguarding Practice Review (see also Working Together to Safeguarding Children, gov.uk) and in respect of persons aged 16 or over, which provides for a  Domestic Homicide Review (DHR) (see Multi-agency Statutory Guidance for the Conduct of Domestic Homicide Reviews, Home Office).

These two sets of statutory guidance overlap where the victims are aged between 16 and 18.  When commissioning a SAR there will be consideration of how it how will dovetail with other statutory reviews and any other investigations.

The guidance for DHR states consideration should be given to how the Child Safeguarding Practice Reviews and DHRs can be managed in parallel in the most effective way, so that organisations/professionals can learn from the case. Different types of reviews will have their own specific areas of investigation and these should be respected. Where intelligence can be shared across reviews, there should be no organisational barriers to information sharing. It is also helpful to consider if some aspects of the reviews can be commissioned jointly to reduce duplication.

16. Coroners

Any SAR may need to take account of a Coroners’ inquiry, including disclosure issues, to ensure that relevant information can be shared without incurring significant delay. Coroners are independent judicial officer holders who are responsible for investigating violent, unnatural deaths or deaths of unknown cause, and deaths in custody, or otherwise in state detention, which are reported to them. The Coroner may have specific questions arising from the death of an adult, these include:

  • where there is an obvious and serious failing by one or more organisations;
  • where there are no obvious failings, but the actions taken by organisations require further exploration/explanation;
  • where a death has occurred and there are concerns for others in the same household or other setting (such as a care home);
  • deaths that fall outside the requirement to hold an inquest but follow-up enquiries/actions are identified by the Coroner or their officers.

Where the Coroner identifies issues such as these, the SAB will consider whether a SAR is required.

17. Findings from SARs

The findings and outcomes of any SAR will be captured within the Safeguarding Adults Board Annual Report and online (see Local Safeguarding Adult Reviews, South Tyneside Council website)

18. Timetable

The timescale from the decision to conduct a SAR to completion is six months. In the event that the SAR is likely to take longer for example, because of potential prejudice to related court proceedings, the adult/advocate and others will be advised in writing the reasons for the delay and kept updated on progress.

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RELEVANT CHAPTERS

Safeguarding: What is it and Why does it Matter?

RELEVANT INFORMATION

Chapter 14, Care and Support Statutory Guidance (Department of Health and Social Care)

1. Context

The Care Act 2014 put adult safeguarding on a legal footing and required each local authority to set up a Safeguarding Adults Board (SAB) with core membership from the local authority, the police and the NHS (specifically the local Integrated Care Board). Locally this is called the South Tyneside Safeguarding Adults Board (SAB).

One of the key functions of the SAN is to ensure that the policies and procedures governing adult safeguarding are fit for purpose and can be translated into effective adult safeguarding practice.

South Tyneside SAB has implemented this procedural framework to ensure consistency across South Tyneside in the way in which adults are safeguarded from abuse and neglect. All organisations involved in safeguarding are asked to adopt this policy and procedures in respect of their relevant roles and functions, but may wish to add additional organisation specific practice guidance, protocols and organisation operation manuals.

2. Principles of Adult Safeguarding

See also Making Safeguarding Personal chapter

The policy and procedures are based on the six principles of safeguarding (see Chapter 14, Care and Support Statutory Guidance ) that underpin all adult safeguarding work. See the Safeguarding: What it is and why does it Matter? chapter for more information.

South Tyneside’s multi-agency adult safeguarding policy and procedures are built on strong multi-agency partnerships working together, with adults, to prevent abuse and neglect where possible, and provide a consistent approach when responding to safeguarding concerns. This entails joint accountability for the management of risk, timely information sharing, co-operation and a collegiate approach that respects boundaries and confidentiality within legal frameworks.

3. Risk Management

Safeguarding is fundamentally managing risk about the safety and wellbeing of an adult in line with the six safeguarding principles (see Safeguarding: What it is and why does it Matter?). The aim of risk management is:

  • to promote, and thereby support, inclusive decision making as a collaborative and empowering process, which takes full account of the individual’s perspective and views of primary carers;
  • to enable and support the positive management of risks where this is fully endorsed by the multi-agency partners as having positive outcomes;
  • to promote the adoption by all staff of ‘defensible decisions’ rather than ‘defensive actions’.

Effective risk management strategies identify risks and provide an action or means of mitigation against each identified risk, and have a mechanism in place for early escalation if the mitigation is no longer viable. Contingency arrangements should always be part of risk management. Risk assessments and risk management should take a holistic approach and partners should ensure that they have the systems in place that enable early identification and assessment of risk through timely information sharing and targeted multi-agency intervention. (See Managing Risk chapter).

4. Inter-agency Cooperation

The importance of effective multi-agency working is a common finding from Safeguarding Adults Reviews. South Tyneside Council, as the local authority, is the lead coordinating organisation for adult safeguarding. However, all other relevant organisations and partners including the NHS, the Department for Work and Pensions, the police and HM Prison and Probation Service have legal duties in relation to safeguarding adults.

Organisations can achieve effective inter-agency working through creative joint working partnerships that focus on positive outcomes for the individual(s). Cooperation between organisations that take a broad community approach to establishing safeguarding arrangements, working together on prevention strategies and awareness-raising also supports the aims and objectives of South Tyneside’s Health and Wellbeing Board and Community Safety Partnership (see South Tyneside Safeguarding Adults Structures and Organisations).

The local authority and partner organisations should cooperate in order to deliver effective safeguarding, both at a strategic level and in individual cases, where they may need to ask one another to take specific action in that case.

The Care Act 2014 describes a general duty to cooperate between the local authority and other organisations providing care and support. This includes a duty on the local authority itself to ensure cooperation between its adult care and support, housing, public health and children’s services.

It also provides a new ability to request cooperation from a relevant partner or another local authority, in relation to an individual case. The local authority or relevant partner must cooperate as requested, unless doing so would be incompatible with their own duties or have an adverse effect on the exercise of their functions.

If an organisation is refusing to share information, the organisation conducting an enquiry can escalate to the Safeguarding Adults Board (SAB) to consider using Care Act powers, which place an obligation on organisations to comply with a request for information in order that the SAB can perform its duties.

The Care Act sets out five aims of cooperation between partners which are relevant to care and support, although it should be noted that the purposes of cooperation are not limited to these matters. The five aims include:

  1. promoting the wellbeing of adults needing care and support and of carers;
  2. improving the quality of care and support for adults and support for carers (including the outcomes from such provision);
  3. smoothing the transition from children’s to adults’ services;
  4. protecting adults with care and support needs who are currently experiencing or at risk of abuse or neglect and
  5. identifying lessons to be learned from cases where adults with needs for care and support have experienced serious abuse or neglect.

Organisations that refuse to comply with requests for cooperation or information should provide written reasons for the refusal.

5. Information Sharing

Sharing the right information, at the right time with the right people, is fundamental to good safeguarding practice, but it has also been highlighted as a difficult area of practice. The Care Act ‘supply of information’ duty covers the responsibilities of others to comply with requests for information as detailed above. Sharing information between organisations as part of day to day safeguarding practice is already covered in the common law duty of confidentiality, data protection legislation (see Data Protection Act chapter), the Human Rights Act 1998 and the Crime and Disorder Act 1998.

As a general principle people must assume it is their responsibility to raise a safeguarding concern if they believe an adult at risk is suffering or likely to suffer abuse or neglect, and / or are a risk to themselves or another, rather than assume someone else will do so. They should share the information with the local authority and/or the police if they believe or suspect that a crime has been committed or that the individual is immediately at risk.

Helpful guidance is set out in the Caldicott Principles.

Partner organisations may be asked to share information through agreed information sharing protocols. See South Tyneside Multi Agency Information Sharing Agreement.

6. Confidentiality

A duty of confidence arises when sensitive personal information is obtained and / or recorded in circumstances where it is reasonable for the subject of the information to expect that the information will be held in confidence.

Adults provide sensitive information and have a right to expect that the information that they directly provide and information obtained from others will be treated respectfully and that their privacy will be maintained.

The challenges of working within the boundaries of confidentiality should not impede taking appropriate action. Whenever possible, informed consent to the sharing of information should be obtained. However:

  • emergency or life threatening situations may warrant the sharing of relevant information with the relevant emergency services without consent;
  • the law does not prevent the sharing of sensitive, personal information within organisations. If the information is confidential, but there is a safeguarding concern, sharing it may be justified;
  • the law does not prevent the sharing of sensitive, personal information between organisations where the public interest served outweighs the public interest served by protecting confidentiality – for example, where a serious crime may be prevented.

Whether information is shared with or without the adult’s consent, the information sharing process should abide by the principles of the Data Protection Act 2018. In those instances where the person lacks the mental capacity to give informed consent, staff should always bear in mind the requirements of the Mental Capacity Act 2005, and whether sharing it will be in the person’s best interest (see also Mental Capacity chapter).

The data protection legislation should not be a barrier to sharing information. It provides a framework to ensure that personal information about living persons is shared appropriately.

7. Wellbeing

The Care Act states that local authorities must promote wellbeing when carrying out any of their care and support functions in respect of a person. This may sometimes be referred to as ‘the wellbeing principle’ because it is a guiding principle that puts wellbeing at the heart of care and support. For safeguarding, this would include safeguarding activities in the widest community sense and is not confined to safeguarding enquiries under Section 42 of the Care Act 2014.

The Care and Support Statutory Guidance supports the need for safeguarding to be person led and outcome focused.

“14.14. In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals. We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised; and the case study below helps illustrate this.

14.15. Making safeguarding personal means it should be person-led and outcome focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.”

Wellbeing is a broad concept, and it is described as relating to the following areas:

  • personal dignity (including treatment of the individual with respect):
  • physical and mental health and emotional wellbeing;
  • protection from abuse and neglect;
  • control by the individual over day to day life (including over care and support provided and the way it is provided);
  • participation in work, education, training or recreation;
  • social and economic wellbeing;
  • domestic, family and personal;
  • suitability of accommodation;
  • the individual’s contribution to society.

All organisations working with adults who are or may be experiencing or at risk of abuse and neglect, must aim to ensure that they remain safeguarded. This should underpin every activity through consistent safeguarding adults work. This includes any safeguarding activity that is outside the scope of a Section 42 Care Act 2014 enquiry.

The wellbeing principle should apply to all agencies involved in safeguarding adults.

8. Organisational Learning

It is essential that all aspects of safeguarding practice are monitored and scrutinised on a regular basis. All staff have a responsibility to audit their work.

All agencies need to take responsibility for organisational learning and implement changes to their practice as a result of audits, complaints, Safeguarding Adult Reviews, and most importantly feedback from adults about what works well and what needs to improve. Organisations need to provide opportunities for their staff for learning from themes and patterns of practice that can add value to learning from good practice; pinpointing necessary changes.

9. Values

South Tyneside Safeguarding Adults Board expects safeguarding to be given the highest priority across all organisations. There must be a shared value of placing safeguarding within the highest of corporate priorities. Organisations should be judged on the effectiveness of safe communities and their values towards safeguarding adults who may be at risk of, or experiencing abuse or neglect.

These values include:

  • people are able to access support and protection to live independently and have control over their lives;
  • appropriate safeguarding options should be discussed with the adult according to their wishes and preferences. They should take proper account of any additional factors associated with the individual’s disability, age, gender, sexual orientation, race, religion, culture or lifestyle;
  • the adult should be the primary focus of decision making, determining what safeguards they want in place and provided with options so that they maintain choice and control;
  • all action should begin with the assumption that the adult is best placed to judge their own situation and knows best the outcomes, goals and wellbeing they want to achieve;
  • the individual’s views, wishes, feelings and beliefs should be paramount and are critical to a personalised way of working with them;
  • there is a presumption that adults have mental capacity to make informed decisions about their lives. If someone has been assessed as not having mental capacity, to make decisions about their safety, decision making will be made in their best interests as set out in the Mental Capacity Act 2005 and Mental Capacity Act Code of Practice;
  • people will have access to supported decision making;
  • adults should be given information, advice and support in a form that they can understand and be supported to be included in all forums that are making decisions about their lives. The maxim ‘no decision about me without me’ should govern all decision making;
  • all decisions should be made with the adult and promote their wellbeing and be reasonable, justified, proportionate and ethical;
  • timeliness should be determined by the personal circumstances of the adult;
  • every effort should be made to ensure that adults are afforded appropriate protection under the law and have full access to the criminal justice system when a crime has been committed.
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