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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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

RELEVANT GUIDANCE

Out-of-Area Safeguarding Arrangements (ADASS)

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 adopted in the ADASS Out of Area Safeguarding Adults Arrangements protocol, and are similarly used here:

  • 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. ADASS Principles for Out of Area Safeguarding Adult Arrangements

ADASS states 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.

In relation to the placing authority ADASS states it 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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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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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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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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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 by people in positions of trust where there is ill treatment and wilful neglect. There are a number of possible offences which may apply, including the specific offences mentioned below. 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. Click here to view 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

The report should be tested that it meets the standards above, 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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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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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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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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