1. Introduction

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

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

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

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

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

2. Definition

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

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

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

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

3. Key Principles

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

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

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

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

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

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

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

4. Timescales

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

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

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

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

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

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

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

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

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

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

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

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

Stage 4 – Formal Consideration by STSCP /STSAB

Upon receipt of the information:

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

5. Recording and Reporting

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

6. Quality Assurance

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

Appendix A: Escalation Notification Form / Template

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

Appendix B: Escalation Flowchart

Escalation Flowchart for Adults and Children (opens as pdf)

1. Introduction

This guidance has been created to support implementation of the requirements in the Care and Support Statutory Guidance that deal with ‘allegations against people in a position of trust’ (paragraphs 14.120 to 14.132). This guidance is designed to be read in conjunction with the statutory guidance and relevant information sharing guidance/ legislation.

The Care Act 2014 recognises that safeguarding concerns are not always in relation to the safety and wellbeing of an individual, but rather they relate to the possible risk posed more widely by a person in a position of trust to people with care and support needs.

Where a person is experiencing or is at risk of abuse, the online multi-agency safeguarding adults policies and procedures should be followed (see How to Report a Concern). The purpose of the online multi-agency safeguarding adults policies and procedures is to provide guidance for organisations to work together, and with one or more specific people at risk of abuse, to support them to be safe.

In both cases, this guidance will be relevant in supporting the work of all agencies to prevent abuse and neglect. Its purpose is to:

This guidance is designed to inform and support the decision making of Partnership member organisations and wider partner agencies once they become aware of a concern within the scope of this guidance.

2. Scope of this Guidance

For the purposes of this guidance:

Examples of such concerns could include allegations that the person in a position of trust has:

• behaved in a way that has harmed, or may have harmed an adult or child
• possibly committed a criminal offence against, or related to, an adult or child
• behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

(Care and Support Statutory Guidance, paragraph 14.123)

Such incidents may have occurred within the person’s home / personal life, as well as within their employment, volunteering role or studies. Wherever it has occurred however, there is now a potential risk to adults with care and support needs.

3. Referrals / Pathways: Person / People in Positions of Trust

3.1 Safeguarding Adults Concerns

Please note: if you have concerns that a specific person with care and support needs it as risk or is experiencing abuse or neglect, follow the South Tyneside Multi Agency Safeguarding Adults Policies and Procedures

Report your concerns by contacting:

0191 424 6000 (Monday to Thursday – 8.30am to 5pm, Friday 8.30am to 4.30pm)

0191 456 2093 (outside of the above office hours).

3.2  People in Position of Trust Concerns

A person in a position of trust is an employee, volunteer or student who works with adults with care and support needs. This work may be paid or unpaid.

Examples of such concerns could include allegations that they have:

• behaved in a way that has harmed, or may have harmed an adult or child
• possibly committed a criminal offence against, or related to an adult or child
• behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs.

3.2.1 What you should do

If you are an organisation i.e. employer, volunteer manager, student body, of the person in a position of trust; you must assess and manage risk as set out in this guidance. If the person also works with another organisation, you will need to consider the need to share information to also protect people within that service (See Section 6, Information Sharing).

If you are not the person’s employer, volunteer manager, student body, or the concerns are in relation to a personal assistant, employed by a person with care and support needs; or if you need additional advice and support in relation to people in positions of trust concerns contact the South Tyneside PIPOT Lead by emailing safeguardingadults@southtyneside.gov.uk  to request a referral form or for someone to call you back to discuss the case.

See Appendix E for the PIPOT Referral Form.

4. Responsibilities of Employers / Volunteer Organisations and Student Bodies

The Care and Support Statutory Guidance sets out the responsibilities of employers:

• The local authority’s relevant partners[1], as set out in Section 6 (7) of the Care Act 2014, and those providing universal care and support services[2], should have clear policies in line with those from the safeguarding adults board for dealing with allegations against people who work, in either a paid or unpaid capacity, with adults with care and support needs (Section 14.120)
• Where such concerns are raised about someone who works with adults with care and support needs, it will be necessary for the employer (or student body or voluntary organisation) to assess any potential risk to adults with care and support needs who use their services, and, if necessary, to take action to safeguard those adults (Section 14.122)
• Employers, student bodies and voluntary organisations should have clear procedures in place setting out the process, including timescales, for investigation and what support and advice will be available to individuals against whom allegations have been made (Section 14.126)
• Employers, student bodies and voluntary organisations should have their own sources of advice (including legal advice) in place for dealing with such concerns (Section 14.126)
• …action necessary to address the welfare of adults with care and support needs should be taken without delay and in a coordinated manner, to prevent the need for further safeguarding in future (Section 14.128)
• If an organisation [permanently] removes an individual (paid worker or unpaid volunteer) from work with an adult with care and support needs (or would have, had the person not left first) because the person poses a risk of harm to adults, the organisation must make a referral to the Disclosure and Barring Service. It is an offence to fail to make a referral without good reason (Section 14.127. Italics comment added)

Each organisation must therefore ensure they have policies and procedures in place that enable them to respond to concerns about people in positions of trust. This must include arrangements for raising concerns to the local authority in accordance with the multi-agency safeguarding adults policies and procedures where this is appropriate, as well as the management of concerns within their own organisation.

Employers and student bodies are responsible for working with the person in a position of trust to understand the issues, assess any risk in the context of their service; and take appropriate actions that safeguard people who use their services. This will include supporting the person in position of trust to understand the process being followed and decisions reached in accordance with the organisations policies.

Only an employer has the power to suspend an employee, redeploy them or make other changes to their working arrangements, and so must be responsible and accountable for the decisions reached.  Actions taken should take into account their own internal policies and procedures, their responsibilities to provide safe services, and employment law.  According to the nature of the concerns raised, and employer/volunteers organisation/student body may also have a responsibility to inform overseeing bodies according to their requirements, such as:

• Care Quality Commission (CQC)
• Charity Commission
• Commissioning Bodies
• Disclosure and Barring Service (DBS)
• Professional Bodies

[1] Relevant partners include NHS bodies, chief officer of the police, relevant provider of probation services.

[2] Universal care and support services will include those services available to all, such as leisure and housing services, preventative services, as well as services provided in relation to the care and support needs of adults.

5. Guidance for the Local Authority

5.1 Concerns about a person in a position of trust

If the local authority is given information about concerns that do not relate to the safety of identified adults with care and support needs, but rather the potential risk posed by a person in a position of trust, use of multi-agency procedures will not usually be the way to respond to the concerns.

In these situations, this people in positions of trust guidance will need to be followed:

Where the concern is raised by an employer, volunteer manager or student body:  The local authority may need to signpost agencies to this guidance for them to take precautionary actions as appropriate in relation to identified risks. Employers, volunteer managers and student bodies would need to be responsible for taking actions within this guidance as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies. Employers, volunteer managers and student bodies that are raising concerns will often be best placed to share information with another employer, volunteer manager or student body, if it is so justified and necessary to do so as set out in Section 6, Information Sharing. There may, however, be circumstances where the local authority is best placed and so this decision will need to made on a case by case basis.

Where the concern is not raised by an employer, volunteer manager or student body: The local authority will need to determine whether it is justified and necessary to share the concerns with an employer, volunteer manager or student body as set out in Section 6, Information Sharing. The local authority may need to signpost agencies to this guidance, for them to take precautionary actions as appropriate in relation to identified risks. Employers, volunteer managers and student bodies would need to be responsible for taking actions within this guidance as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies.

Where the person in a position of trust is a personal assistant, employed by a person with care and support needs, the local authority may need to provide the employing individual with additional support to understand and manage the risks effectively and to access appropriate support.

5.2 Working within the multi-agency safeguarding adults procedures

Where the concern involving a person in a position of trust relates to an identified person or people with care and support needs, use of the multi-agency safeguarding adults policies and procedures will usually be appropriate.

In such a situation:

• The people in positions of trust practice guidance should be followed alongside the multi-agency safeguarding adults policies and procedures.
• Employers, volunteer organisations and student bodies retain responsibility for actions as set out in Section 4, Responsibilities of Employers / Volunteer Organisations and Student Bodies.
• to prevent abuse or neglect in their setting.
• If, during the course of working within the multi-agency safeguarding adults policies and procedures, it is identified that the person in a position of trust may pose a risk in another setting, there will need to be a consideration as to which agency is best placed to share information as may be required with other employers, volunteer managers or student bodies to prevent abuse or neglect (see Section 6, Information Sharing). This will need to be on a case-by-case basis, taking into account the need to assess the risk and engage with the person in a position of trust as set out in this guidance.

6. Information Sharing

Where an organisation has information relating to the risk posed by a person in a position of trust, they have a responsibility to consider whether this information needs to be passed on to ensure risks are appropriately considered and managed.

Each organisation is individually responsible for ensuring that concerns relating to a person in a position of trust are shared, where necessary and appropriate, with other organisations to prevent abuse and neglect.

The potential need to share information with an employer / volunteer organisation or student body will be indicated when there is a reasonable cause to suspect that a person in a position of trust may pose a risk to adults with care and support needs within another service. This may include situations such as where:

• a member of staff has been suspended pending a disciplinary or safeguarding enquiry, and who is known to be carrying out a similar role working within another organisation where they are assessed as potentially posing an immediate risk to others.
• a member of staff has been dismissed due to their behaviour towards adults with care and support needs, and is also known to be undertaking professional training, for example, as a social worker or as a health professional.
• an employee’s role and responsibilities have been changed in response to dangerous practice, but they continue to have a similar role within another organisation, where they may pose a risk to people who use that service.

Public bodies or organisations commissioned by them should be considered to be undertaking a public task as a lawful basis for sharing information. Other agencies not fulfilling public tasks should consider relying on legitimate interests as a lawful basis for sharing information.

Even where you do not have consent to share confidential information, you may lawfully share it in the public interest. Seeking consent should be the first option. However, where consent cannot be obtained or is refused, or where seeking it is inappropriate or unsafe, the question of whether there is enough public interest must be judged by the practitioner on the facts of each case. Therefore, where you have a concern about a person, you should not regard refusal of consent as necessarily precluding the sharing of confidential information.

A public interest can arise in a wide range of circumstances, for example, to protect children from significant harm, protect adults from serious harm, promote the welfare of children or prevent crime and disorder. There are also public interests which may, in some circumstances, weigh against sharing, including the public interest in maintaining public confidence in the confidentiality of certain services.

In both cases however, the judgement to be made is the same. In deciding whether sharing the information is justified and necessary, a professional judgement will be required based upon balancing the safety and needs of those potentially at risk, and the rights of the employee / volunteer or student as described below:

• A fair balance must be struck between the rights of the person in a position of trust to privacy and the interests of those at risk of abuse and neglect. This requires a careful assessment of the severity and consequences of the interference in the life of the person in a position of trust and the risk posed to others.
• The risks to adults with care and support needs must be sufficient to justify interfering with the person in a position of trusts’ right to privacy. The consideration is therefore one of proportionality – there should be a need for the disclosure in order to protect adults with care and support needs.

• If it is reasonably believed that the sharing of information will achieve the aim of preventing abuse or neglect, there should be no more interference in the person’s right to privacy than is necessary to achieve this aim.

It will be important to record your judgement, your reasons for sharing or not sharing the information, the factors you have considered and why you have give weight to some factors more than others. The recording templates (Appendix H – Template Minutes for Planning Meeting and Appendix I – Template Minutes for Case Closure Meeting can be used where it is helpful, to support decision making and the recording of decisions).

6.1 Consent and involvement of the person in a position of trust

Unless wholly impractical, before disclosing information to another employer, volunteer manager or student body, there is a need to consult with the person whose information is to be shared. This will give them the opportunity to respond to the concerns and make representation on the need to share the information.

If it is assessed as justified and necessary for the employer to be informed of the concerns / allegations, the person in a position of trust may wish to inform the employer / volunteer organisation / student body themselves.

If this is the case, their wish should be respected, but it will still be necessary to contact the employer / volunteer organisation / student body to subsequently check that relevant information has actually been passed on. It should be made clear to the person in a position of trust that this is required.

Whilst it is important to work with the person in a position of trust and seek their agreement to share information wherever possible, consent will not always be considered a lawful basis to share information in such situations. Consent must be freely given, specific and informed and the imbalance of power in such situations may mean that it cannot always be relied upon. In such cases, decisions need to be proportional to the concern as set out above.

However, this does not preclude in any way the responsibility to consult with the person in the position of trust unless it is wholly impractical to do or may place someone at risk.

7. Working with the Local Authority Designated Officer (LADO)

If there is concern that a person in a position of trust may, in the course of their work, pose a risk to child or young person under the age of 18 years, then the local authority designated officer should be notified and actions taken within the LADO process.

Sometimes, however, the risk may relate to both children / young people and adults. In such cases, there will be a need for organisations and safeguarding leads to consider their responsibilities under both this guidance and the LADO process.

8. Record Keeping

Recording of discussions, decisions and disclosures are essential, and each organisation must ensure that it has process for recording this information in accordance with their own policies and any legal requirements.

Templates are available in the appendices:

Appendix H – Template Minutes for Planning Meeting

Appendix I – Template Minutes for Case Closure Meeting

9. Illustrative Examples

The examples below show how to apply this the guidance as part of an organisation’s management process:

Example 1 – John and Mary

Example 2 – Tina

Example 3 – Emma

Appendix A – Flowchart: Managing Concerns and Allegations Against People who Work with Adults with Care and Support Needs

Appendix A – PIPOT Flowchart

Appendix B – Best Practice Guidance when Deciding to Disclose Information.

Appendix B – Best Practice when Deciding to Disclose Information

Appendix C – Position of Trust Risk Balance Sheet

Appendix C- Position of Trust Risk Balance Sheet

Appendix D – Factors to Consider Regarding PIPOT Notifications

Appendix D – Factors to Consider Regarding PIPOT Notifications

Appendix E – PIPOT Referral Form

Appendix E – Allegations Against People who Work in Positions of Trust with Adults Referral / Reporting Form

Appendix F – Template Agenda for Planning Meeting

Appendix F – Template Agenda for Planning Meeting or Planning Discussion

Appendix G – Template Agenda for Case Closure Meeting

Appendix G – Template Agenda for Case Closure Meeting

Appendix H – Template Minutes for Planning Meeting

Appendix H – Template Minutes for Planning Meeting or Planning Discussion

Appendix I – Template Minutes for Case Closure Meeting

Appendix I – Template Minutes for Case Closure Meeting

 

1. Introduction

Being involved in a safeguarding process is a difficult experience for any adult who has experienced neglect or abuse, and the people who care for them.

Practitioners should make every effort to ensure that adults and their carers are fully consulted and involved in the safeguarding process, kept informed of the progress of any investigation and are at the centre of work to ensure their safety and wellbeing (see Making Safeguarding Personal chapter).

However, there will be occasions when an adult or their carer wish to make a complaint about their experience or the outcome of the safeguarding process.

Where the adult or carer wishes to make a complaint about an individual organisation, they should be directed to the organisation’s complaints procedure.

For professionals who wish to complain about an aspect of the process, please see Escalation Protocol: Resolution of Professional Disagreements between Workers Relating to the Safety of Adults.

At any stage of the complaints process, the adult or carer may bring an advocate or friend to support them. An independent advocate can make a complaint on behalf of an adult (see Independent Advocacy chapter). Some adults or carers may require interpreting or communication services (see the chapter on Interpreting, Signing and Communication Needs).

When a representative makes a complaint on behalf of the adult, written confirmation will normally be required – as far as this is possible to give – that the person is happy for this representation to take place and if appropriate for relevant information to be shared directly with the representative.

The representative in a complaint covered by this procedure will be expected to discuss  and disclose relevant details of the complaints and its progress with the adult as far as possible, and ensure that any decisions made about the complaint has their full agreement.

South Tyneside Council has the discretion to decide whether or not the person is suitable to act as a representative.  If the representation is considered to be unsuitable, or not in the adult’s best interests, the person acting as a representative will be informed in writing of the reasons why their representation has been refused.  This test of suitability will be applied when the complaint is first made, and also at relevant stages of the complaint, as appropriate.

The local authority should ensure people are given information and advice about the complaints process, that they are supported throughout and kept fully informed in writing of progress and the outcome.

2. Grounds for Complaint or Appeal

The adult who is experiencing or at risk of abuse or neglect (or advocate on their behalf) or their carer has grounds for making a complaint if they are unhappy with the manner in which they feel they have been treated during the safeguarding process.

3. Complaints Procedure

The complaints procedure has three stages.

3.1 Stage 1

The focus on Stage 1 is on putting things right.

The adult or their carer who wishes to make a complaint should first speak to a practitioner involved in the safeguarding process. This may be a social worker or health professional.

If they are not satisfied with the discussion at this level, the practitioner should ask them if they would like to speak to their line manager or the organisation’s safeguarding adult lead. The manager should discuss the situation with the adult / carer, and try to resolve the situation informally. This may be by explaining processes to them and the rationale for the decisions made or actions taken or taking action to remedy an aspect of the process. The adult / carer should be reassured that their concerns are taken seriously.

If the complaint is straightforward, it may be resolved at this stage.

The practitioner / manager should record a summary of all discussion/s which take place and the outcome (see Case Recording).

If the adult / carer remains dissatisfied ,they can ask for a formal investigation of their complaint under Stage 2 of the complaints procedure.

3.2 Stage 2

Where it has not been possible to resolve the complaint via discussion, the Customer Services Department will be informed.  The complaint will be  passed to a senior manager to carry out an investigation. That person will not have had any prior involvement in investigating the complaint.

The complainant will be sent a letter from the Customer Services Department to acknowledge that their complaint has been moved to Stage 2. The target response time is 15 working days.  If more time is needed to complete the investigation, the complainant will be contacted within the 15 working days and informed of what is happening by the Investigating Officer.

The Customer Services department and South Tyneside Safeguarding Children and Adults Partnership Manager should be informed of the outcome of Stage 2.

Should the complainant remain dissatisfied with the outcome of the investigation they can write to the Chief Executive within 28 days, requesting that their complaint is investigated under Stage 3 of the Complaints procedure

3.3 Stage 3

The Chief Executive will appoint a colleague to investigate the complaint on their behalf.  The Investigating Officer will not have had any prior involvement in dealing with the complaint and will not be employed in the service area that is being complained about.  The Customer Services Department will write to the complainant to advise them that their complaint will be investigated at Stage 3 and inform them of the name of the person dealing with it.  The Investigating officer will respond to the complainant directly with their findings. A full response will then be sent to them within 20 working days.  If more time is needed to complete the investigation the complainant will be informed  by the Investigating Officer within the 20 working days.

Should the complainant remain unhappy with the response they can ask the Local Government and Social Care Ombudsman to take up their complaint.

 

1. Introduction

Roles and responsibilities should be clear and collaboration should take place at all the following levels:

• operational;
• supervisory line management;
• practice leadership;
• strategic leadership within the senior management team;
• corporate / cross authority;
• chief officers / chief executives;
• local authority members and local police and crime commissioners;
• commissioners;
• providers of services;
• voluntary organisations;
• regulated professionals.

2. Operational Frontline Staff

See also Safeguarding Enquiries Process, Making Safeguarding Personal, Supervision, Safeguarding Training for Staff and Volunteers.

Operational frontline staff are responsible for identifying and responding to allegations of abuse and substandard practice. Staff at operational level need to share a common view of what types of behaviour may be abuse or neglect and what to do as an initial response to a suspicion or allegation that it is or has occurred. This includes GPs. It is the employers and commissioners duty to set these out clearly and reinforce regularly.

It is not for frontline staff to second guess the outcome of an enquiry in deciding whether or not to share their concerns. There should be effective and well publicised ways of escalating concerns where immediate line managers do not take action in response to a concern being raised.

Concerns about abuse or neglect must be reported whatever the source of harm is. It is imperative that poor or neglectful care is brought to the immediate attention of managers and responded to swiftly, including ensuring immediate safety and wellbeing of the adult. Where the source of abuse or neglect is a member of staff it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

There should be clear arrangements in place about what each agency should contribute at this level. These will cover approaches to enquiries and subsequent courses of action. The local authority is responsible for ensuring effective co-ordination at this level.

See also Safeguarding Case Studies.

3. Line Managers’ Supervision

See also Safeguarding Enquiries Process, Making Safeguarding Personal, Supervision, Safeguarding Training for Staff and Volunteers.

Skillful and knowledgeable supervision focused on outcomes for adults is critically important in safeguarding work. Managers have a central role in ensuring high standards of practice and that practitioners are properly equipped and supported. It is important to recognise that dealing with situations involving abuse and neglect can be stressful and distressing for staff and workplace support should be available.

Managers need to develop good working relationships with their counterparts in other agencies to improve cooperation locally and swiftly address any differences or difficulties that arise between front line staff or managers.

They should have access to legal advice when proposed interventions, such as the proposed stopping of contact between family members, or if it is unclear whether proposed serious and / or invasive medical treatment is likely to be in the best interests of the adult who lacks capacity to consent, require applications to the Court of Protection.

4. Practice Leadership

All social workers undertaking work with adults should have access to a source of additional advice and guidance particularly in complex and contentious situations. Principal social workers are often well placed to perform this role or to ensure that appropriate practice supervision is available.

Principal social workers in the local authority are responsible for providing professional leadership for social work practice in their organisation and organisations undertaking statutory responsibilities on behalf of the local authority. Practice leaders / principal social workers should ensure that practice is in line with the Care and Support Statutory Guidance.

Making safeguarding personal represents a fundamental shift in social work practice and underpins all healthcare delivery in relation to safeguarding, with a focus on the person not the process. As the professional lead for social work, principal social workers and senior healthcare safeguarding professionals should have a broad knowledge base on safeguarding and making safeguarding personal and are confident in its application in their own and others’ work.

All providers of healthcare should have in place named professionals, who are a source of additional advice and support in complex and contentious cases within their organisation. There should be a designated professional lead in the ICB, who is a source of advice and support to the governing body in relation to the safeguarding of individuals and is able to act as the lead in the management of complex cases.

All commissioners and providers of healthcare should ensure that staff have the necessary competences and that training in place to ensure that their staff are able to deliver the service in relation to the safeguarding of individuals. Many of the police investigators involved in safeguarding investigations are specially trained for that role and work in specialist units. Each of those units has a set of arrangements to help provide advice and guidance to ensure that a thorough investigation takes place in order to achieve successful outcomes for the individual.

The police service itself has identified ways that enable non-specialist officers to seek advice from supervisors at every stage of the safeguarding process, even when specialist departments are unavailable.

5. Strategic Leadership within the Senior Management Team

Each Safeguarding Adults Board (SAB) member agency – local authority, Integrated Care Board (ICB) and police, should identify a senior manager to take a lead role in the organisational and in inter-agency arrangements, including the SAB.

In order for the SAB to be an effective decision making body providing leadership and accountability, members need to be sufficiently senior within their organisation and have the authority to commit the required resources and able to make strategic decisions.

To achieve effective working relationships, based on trust and transparency, members will need to understand the contexts and restraints within which their counterparts work.

Police forces in England and Wales have a head of public protection who has strategic management responsibility for all aspects of protecting people in vulnerable situations, including adults at risk of, or are experiencing, abuse or neglect. The role of the head of public protection is to build an effective working team and develop a multi-agency approach into alleged offences involving people in vulnerable circumstances. They will also have responsibility for managing and developing policy that ensures standardised processes of investigation and working practice throughout each force. The police and ICBs are represented at a strategic level on every local Safeguarding Adults Board and contact details for the individuals concerned will be available to the SAB and all its members.

6. Corporate / Cross Authority Roles

To ensure effective partnership working, each organisation must recognise and accept its role and functions in relation to adult safeguarding. These should be set out in the Safeguarding Adults Board strategic plan as well as its own communication channels. They should also have protocols for mediation and family group conferences and for various forms of dispute resolution.

7. Chief Officers and Chief Executives

As chief officer for the leading adult safeguarding agency, the Director of Adult Social Services (DASS) has a particularly important leadership and challenge role to play in adult safeguarding including promoting prevention, early intervention and partnership working.

Taking a personalised approach to adult safeguarding requires a DASS promoting a culture that is:

• person-centred;
• supports choice and control;
• aims to tackle inequalities.

However, all officers, including the chief executive of the local authority, NHS and police chief officers and executives should lead and promote the development of initiatives to improve the prevention, identification and response to abuse and neglect.

They need to be aware of and able to respond to national developments and ask searching questions within their own organisations to assure themselves that their systems and practices are effective in recognising and preventing abuse and neglect. The chief officers must sign off their organisation’s contributions to the strategic plan and annual reports.

Chief officers should receive regular briefings of case law from the Court of Protection and the High Courts.

8. Local Authority Member Level

Local authority members need to have a good understanding of the range of abuse and neglect issues that can affect adults and of the importance of balancing safeguarding with empowerment.

They need to understand prevention, proportionate interventions, the dangers of risk averse practice and the importance of upholding human rights.

Some Safeguarding Adults Board include elected members and this is one way of increasing awareness of members and ownership at a political level.

Others take the view that members are more able to hold their officers to account if they have not been party to decision making, though they should always be aware of the work of the SAB.

Managers must ensure that members are aware of any critical local issues, whether of an individual nature, matters affecting a service or a particular part of the community.

Local Authority Health Scrutiny Functions, such as the local authority’s Health Overview and Scrutiny Committee, Health and Wellbeing Boards (HWBs) and Community Safety Partnerships can play a valuable role in assuring local safeguarding measures, and ensuring that the SAB is accountable to local communities. Similarly, local Health and Wellbeing Boards:

• provide leadership to the local health and wellbeing system;
• ensure strong partnership working between local government and the local NHS; and
• ensure that the needs and views of local communities are represented.

HWBs can therefore play a key role in assurance and accountability of the Safeguarding Adults Board, and local safeguarding measures. Equally the Safeguarding Adults Board may on occasion challenge the decisions of HWBs from that perspective.

9. Commissioners

Commissioners from the local authority, NHS and ICBs are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they place contracts with and ensure that those contracts have explicit clauses that holds the providers to account for preventing and dealing promptly and appropriately with any example of abuse and neglect.

10. Providers of Services

All service providers, including housing and housing support providers, should have clear operational policies and procedures that reflect the framework set by the Safeguarding Adults Board in consultation with them.

This should include what circumstances they need to report outside their own chain of line management, including outside their organisation to the local authority.

They need to share information with relevant partners such as the local authority even where they are taking action themselves.

Providers should be informed of any allegation against them or their staff and treated with courtesy and openness at all times. It is of critical importance that allegations are handled sensitively and in a timely way both to stop any abuse and neglect but also to ensure a fair and transparent process. It is in no one’s interests to unnecessarily prolong enquiries. However some complex issues may take time to resolve.

Provider agencies should produce for their staff a set of internal guidelines which relate clearly to the multi-agency policy and which set out the responsibilities of all staff to operate within it. These should include guidance on:

• identifying adults who are particularly at risk of experiencing abuse or neglect;
• recognising risk from different sources and in different situations and recognising abusive or neglectful behaviour from other service users, colleagues, and family members;
• routes for making a referral and channels of communication within and beyond the agency;
• organisational and individual responsibilities for whistleblowing;
• assurances of protection for whistleblowers;
• working within best practice as specified in contracts;
• working within and co-operating with regulatory mechanisms;
• working within agreed operational guidelines to maintain best practice in relation to:
  • challenging or distressing behaviour;
  • personal and intimate care;
  • control and restraint;
  • gender identity and sexual orientation;
  • medication;
  • handling of people’s money;
  • risk assessment and management.

Internal guidelines should also explain the rights of staff and how employers will respond where abuse is alleged against them within either a criminal or disciplinary context.

11. Voluntary Organisations

Voluntary organisations need to work with commissioners and the Safeguarding Adults Board to agree how their role fits alongside the statutory agencies and how they should work together. This will be of particular importance where they are offering information and advice, independent advocacy, and support or counselling services in safeguarding situations. This will include telephone or online services. Additionally, many voluntary organisations also provide care and support services, including personal care. All voluntary organisations that work with adults need to have safeguarding procedures and lead officers.

12. Regulated Professionals

Staff governed by professional regulation (for example, social workers, doctors, allied health professionals and nurses) should understand how their professional standards and requirements underpin their organisational roles to prevent, recognise and respond to abuse and neglect.

 

1. South Tyneside Safeguarding Adults Board

All local authorities must establish a Safeguarding Adults Board (SAB), as set out in the Care Act 2014. The Act gives the local SAB three specific duties, namely:

• Publish a strategic plan for each financial year that sets out how it will meet its main objective and what each member is to do to implement that strategy. In developing the plan, it must consult the Local Healthwatch organisation and involve the community.
• Publish an annual report detailing what the SAB has done during the year to achieve its objective and what it and each member has done to implement its strategy as well as reporting the findings of any SARs including any ongoing reviews
• Decide when a Safeguarding Adult Review (SAR) is necessary, arrange for its conduct and if it so decides, to implement the findings.

The Social Care Institute for Excellence Safeguarding Adults Board Checklist and Resources provides a comprehensive narrative and account of the roles and responsibilities of the SAB.

2. Links to other Local Partnerships

The Safeguarding Adults Board has links to:

• South Tyneside Community Safety Partnership;
• Health and Wellbeing Board;
• Quality Surveillance Groups;
• North East and North Cumbria Integrated Care Board (ICB); and
• Overview and Scrutiny Committee (OSC).

2.1 Community Safety Partnerships

Community safety partnerships (CSPs) are made up of representatives from the ‘responsible authorities’, which are the:

• police;
• local authority;
• fire and rescue authorities;
• probation;
• health

The responsible authorities work together to protect their local communities from crime and to help people feel safer. They work out how to deal with local issues like anti-social behaviour, drug or alcohol misuse and re-offending. They annually assess local crime priorities and consult partners and the local community about how to deal with them.

2.2 Safeguarding Children Partnership

The Children Act 2004 requires each local authority to establish a Safeguarding Children Partnership for their area and specifies the organisations and individuals (other than the local authority) that should be represented on it. This is called the South Tyneside Safeguarding Children Partnership. The police and health are core members.

2.3 Health and Wellbeing Boards

The Health and Social Care Act 2012 establishes health and wellbeing boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. They are an important feature of the NHS reforms and are key to promoting greater integration of health and local government services. Boards strike a balance between status as a council committee and role as a partnership body.

2.4 Quality Surveillance Groups

Quality Surveillance Groups (QSGs) are primarily concerned with NHS commissioned services: those services that are funded by the NHS, including relevant public health services.

The QSGs are supported by NHS England. They provide an open forum for local supervisory, commissioning and regulatory bodies to share intelligence and give the opportunity to co-ordinate actions to ensure improvements in services. Its purpose is to ensure quality by early identification of risk, and; reduce the burden of performance management and regulation on providers. The strategic links with the Safeguarding Adults Board provides further opportunity to escalate concerns and share risks, and take a sub region view of quality concerns.

3. Senior Strategic Roles

Under the Care Act 2014 the Safeguarding Adults Board should include the local authority, the North East and North Cumbria Integrated Care Board (formerly South Tyneside Clinical Commissioning Group) and the police. The chief officers must sign off their organisation’s contributions to the strategic plan and annual reports. Chief officers should receive regular briefings of case law from the Court of Protection and the High Courts. See also Safeguarding Adults: Roles and Responsibilities in Health and Care Services (Care Quality Commission et al).

4. Role and Function of the Police

Although the police are a mandatory member of the Safeguarding Adults Board, they are not an agency responsible for the provision of care. The police role in adult safeguarding is related to their core policing duties which are to:

• prevent and detect crime;
• keep the peace;
• protect life and property.

5. Other Organisations with Adult Safeguarding Responsibilities

5.1 Care Quality Commission

Safeguarding is a key priority for the Care Quality Commission (CQC) and people who use services are at the heart of their policy. Their work to help safeguard children and adults reflects both their focus on human rights and the requirement within the Health and Social Care Act 2012 to have regard to the need to protect and promote the rights of people who use health and social care services. Health and adult social care regulated services all have a key role in safeguarding vulnerable children and adults at risk. The CQC will monitor how these roles are fulfilled through its regulatory processes by assessing the quality and safety of care provided based on the things that matter to people. It does this by using five key lines of enquiry to ensure that health and social care services provide people with safe, effective, caring, responsive and well led services. Specifically, it considers safeguarding within the ‘Safe’ key line of enquiry.

The CQC will share with local partners, where they are not already aware, the safeguarding information that it receives so that they can take the appropriate action to protect the individual. Safeguarding information is also used within its intelligent monitoring systems in order to assess its impact upon the service and the associated level of risk. This information is then used to inform the CQC inspection process. Although there are differences in the statutory basis and policy context between safeguarding children and adult safeguarding, the CQC have the same approach with an overarching objective of enabling people to live a life free from abuse. The CQC also has a role in health and safety in collaboration with the Health and Safety Executive and local authorities.

5.2 Commissioners

Commissioners from the North East and North Cumbria Integrated Care Board, local authority, and NHS England are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they procure and ensure that contracts have explicit clauses that holds Providers to account for preventing and dealing promptly and appropriately with any concerns of abuse and neglect. Commissioners have a shared and common vision to prevent, reduce and delay the need for care and support. For safeguarding this means, ensuring that people have easy access to information and advice, and early intervention services. Increasingly there is joint commissioning to meet the growing needs within a financial climate of austerity, with greater emphasis on prevention and early intervention. This is in line with the safeguarding principles.

5.3 Community Nursing

Community nurses largely provide treatment in individual’s own homes which includes care homes. A high proportion of people they visit are adults at risk of abuse or neglect by the fact that they have care and support needs and many cannot protect themselves. Community nurses are trained to recognise the signs of abuse and neglect, and to raise their concerns through their line manager, or directly with local authorities. The most common concerns raised relate to neglect.

Through holistic assessments, nursing staff may identity that the person is not getting their health or social care needs met. This could be because of gaps in what is provided by the statutory agencies, or because of decisions made on their behalf by family or friends. Nurses are in a good position to identify possible abuse or neglect particularly financial abuse or domestic abuse, including where this could be a response to the pressures of caring.

Pressure ulcer management and quality of care in care settings, are further areas that nursing staff are able to use their clinical judgements about whether or not abuse and neglect has or is likely to arise. Because community nurses make repeated visits to their patients, they are also in a good position to review risks and the effectiveness of safeguarding plans in response to concerns.

5.4 The Coroner

Coroners are independent judicial officer holders who are responsible for investigating violent, unnatural deaths or deaths of unknown cause, and deaths in custody or otherwise in state detention, which must be reported to them. The Coroner may have specific questions arising from the death of an adult. These are likely to fall within one of the following categories:

• where there is an obvious and serious failing by one or more organisations;
• where there are no obvious failings, but the actions taken by organisations require further exploration / explanation;
• where a death has occurred and there are concerns for others in the same household or setting (such as a care home);
• deaths that fall outside the requirement to hold an inquest but follow-up;
• enquiries / actions are identified by the Coroner or his/ her officers.

5.5 Crown Prosecution Service

The CPS is the principal public prosecuting authority for England and Wales and is headed by the Director of Public Prosecutions. Support is available within the judicial system to support adults at risk to enable them to bring cases to court and to give best evidence. If a person has been the victim of abuse that is also a crime, their support needs can be identified by the police, the CPS and others who have contact with the adult. Witness Care Units exist in all judicial areas and are run jointly by the CPS and the police.

5.6 Court of Protection

The Court of Protection deals with decisions and orders affecting people who lack capacity. The court can make major decisions about health and welfare, as well as property and financial affairs. The court has powers to:

• decide whether a person has mental capacity to make a particular decision for themselves;
• make declarations, decisions or orders on financial and welfare matters affecting individuals who lack capacity to make such decisions;

• appoint deputies to make decisions for persons lacking capacity to make those decisions;
• decide whether a lasting power of attorney or an enduring power of attorney is valid;
• remove deputies or attorneys who fail to carry out their duties.

In most cases decisions about personal welfare will be able to be made legally without making an application to the court, as long as the decisions are made in accordance with the core principles set out in the Mental Capacity Act 2005 and the Best Interests Checklist and any disagreements can be resolved informally. However, it may be necessary and desirable to make an application to the Court in a safeguarding situation where there are:

• particularly difficult decisions to be made;
• disagreements that cannot be resolved by any other means;
• ongoing decisions needed about the personal welfare of a person who lacks capacity to make such decisions for themselves;
• matters relating to property and/or financial issues to be resolved;
• serious healthcare and treatment decisions, for example, withdrawal of artificial nutrition or hydration;
• concerns that a person should be moved from a place where they are believed to be at risk;
• concerns or a desire to place restrictions on contact with named individuals because of risk or where proposed adult safeguarding actions may amount to a deprivation of liberty outside of a care home or hospital.

5.7 Environmental Health

Responsible for health and safety enforcement in businesses, investigating food poisoning outbreaks, pest control, noise pollution and issues related to health and safety. Local authorities are responsible for the enforcement of health and safety legislation in shops, offices, and other parts of the service sector.

5.8 General Practitioners

GPs have a significant role in safeguarding adults. This includes:

• making a referral to a safeguarding adults referral point should they suspect or know of abuse and neglect in line with these procedures;
• playing an active role in planning meetings and safeguarding plans;
• supporting safeguarding actions where there is organisational abuse and / or neglect.

5.9 Health Providers

All health providers are responsible for the safety and quality of services. Health providers are required to demonstrate that they have safeguarding leadership, expertise and commitment at all levels. Health providers are required to have effective arrangements in place to safeguard adults at risk of abuse or neglect and to assure themselves, regulators and their commissioners that these are effective and meet the required standards. Safeguarding arrangements mirror those of the North East and North Cumbria Integrated Care Board. All health service providers are required to be registered with the CQC.

5.10 Named Professionals (Health Providers)

Named professionals have a key role in promoting good professional practice within their organisation, supporting the local safeguarding system and processes, providing advice and expertise for fellow professionals, and ensuring safeguarding training is in place. They should work closely with their organisation’s safeguarding lead, designated professionals and the Safeguarding Adults Board. Safeguarding adult leads support and advise commissioners on adult safeguarding within contracts and commissioned services. They also have responsibility to improve systems and embed referral routes for adults at risk across the health system. They provide a health advisory role to the Safeguarding Adults Board, supporting the North East and North Cumbria Integrated Care Board who sits on the SAB.

5.11 Healthwatch

Healthwatch England is the national consumer champion in health and care and must be consulted on the strategic plan. It has significant statutory powers to ensure the voice of the consumer is strengthened. It challenges and holds to account commissioners, the Regulator and Providers of health and social care services. Healthwatch

• Identifies common problems with health and social care based on people’s experiences
• Recommends changes to health and social care services that they know will benefit people
• Hold those services and decision makers to account and demands action.

As a statutory watchdog, their role is to ensure that health and social care services, and the government, put people at the heart of their care.

5.12 Housing providers

The Care Act states that a Local Authority must consider cooperating with Social Housing Providers in order to exercise its care and support duties. An authority must do this in particular when protecting adults at risk of harm and neglect and when identifying and sharing lessons to be learned from cases of serious abuse or neglect.

5.12.1 Social housing providers 

Registered with, and regulated, by the Homes England and Regulator of Social Housing. They are also known as registered providers of social housing (RPs) or registered social landlords (RSLs). They include local authority landlords, arm’s length management organisations (ALMOs) that manage council housing stock, private for-profit or not-for-profit housing providers, and voluntary sector providers such as alms houses. Most not-for-profit RPs are also known as housing associations.

RPs provide a wide range of housing and housing-related services. They provide much of the supported accommodation in England, such as sheltered housing, care homes, supported living scheme housing, extra care schemes, hostels, foyers for young people, domestic abuse refuges, etc.

5.12.2 Implementing the principles

Beyond the core service of providing housing, RPs may also engage in initiatives that enhance their customers’ wellbeing and create sustainable communities, such as: housing support, community safety, better neighbourhoods, responding to anti-social behaviour, employment & training, domestic abuse, self-neglect and hoarding, fraud awareness, debt & financial inclusion, reducing isolation, tenancy sustainment support, etc.

Local authorities must take into account that the suitability of accommodation is a core component of wellbeing and good housing provision can variously promote that wellbeing. This includes minimising the circumstances, such as isolation, which can make some adults more vulnerable to abuse or neglect in the first place. The nature and diversity of RPs’ work, therefore, can mean that their staff are often well placed to:

Have a good knowledge of the individual and the communities with whom they work:

• be working with persons who are unable to protect themselves from abuse or neglect due to their care and support needs, but who are not already known to adult social care;
• identify individuals experiencing or at risk of abuse or neglect and raise concerns;
• be the first professionals to whom individuals might first disclose abuse or neglect concerns;
• be the only professionals working with the adult;
• provide essential information and advice regarding the adult;
• contribute actively to person-led safeguarding risk assessments and arrangements to support and protect an individual, where appropriate;
• carry out a safeguarding enquiry, or elements of one;
• work with agencies to support someone who is hoarding;
• work together with agencies to resolve issues with someone who refuses support or self-neglects, or when someone may not be eligible for a safeguarding service or social care support;
• work with local authorities to promote safeguarding awareness, information and prevention campaigns;
• be instrumental in helping a local authority to successfully exercise its safeguarding and wellbeing duties.

Housing providers should ensure that they develop a safeguarding culture through:

• partnership and leadership commitment and ownership of safeguarding responsibilities;
• policies or guidance that promote the 6 principles of adult safeguarding;
• policies that reflect the adult safeguarding framework set out by the Safeguarding Adults Board;
• staff being vigilant about adult safeguarding concerns;
• learning and development for staff on adult safeguarding and the MCA enabling them to fulfil their roles and responsibilities;
• sharing information appropriately to safeguard adults at risk and engaging with information sharing agreements where required;
• developing inter-housing networks as well as multi-agency mechanisms.

5.13 North East Ambulance Service (NEAS)

There are a number of ways in which North East Ambulance Service staff may receive information or make observations which suggest that an adult has been abused, neglected or is at risk of abuse and neglect. At a strategic level the six safeguarding principles are embedded into its business plans and aims to translate them into practice by using them to shape strategic and operational safeguarding arrangements.

• Use integrated governance systems and processes to prevent abuse occurring and respond effectively where harm does occur
• Work to support the Safeguarding Adults Board by providing policy updates, and its annual report to support, patients and community partners to create safeguards.
• Provide leadership for safeguard adults policies
• Ensure accountability and use learning within the service and the partnership to bring about improvement

5.14 Tyne and Wear Fire and Rescue Service

Tyne and Wear Fire and Rescue Service (TWFRS) staff become aware of safeguarding concerns in a number of ways, not only when responding to emergency calls, but during community safety preventative work such as during home fire safety visits. TWFRS staff receive safeguarding training to enable them to identify whether an adult has been, or is at risk of being abused and/or neglected, and are aware of how to report concerns.

5.15 Probation Service 

The probation service are responsible for supervising offenders on licence and community orders, and/ or those subject to Multi-Agency Public Protection Arrangement (MAPPA). This work includes preparing pre-sentence reports for courts, preparing parole reports, supervising offenders in approved premises, and delivering sex offender treatment programmes, support to victims of serious violent and sexual offences through the Victim Liaison Unit.

The probation service has a remit to demonstrate a continuous focus on assessment and risk of harm, to protect adults at risk, children and young people, and victims of crime. One of their key objectives is to evidence that routine checks are completed (with appropriate agencies) and information accessed is used to inform the assessment and management of risk in all cases. There is an emphasis on partnership working across South Tyneside at a strategic and local level.

The probation service works in partnership with other agencies through the Multi Agency Public Protection Arrangements (MAPPA). The purpose of the MAPPA framework is to reduce the risks posed by sexual and violent offenders in order to protect the public. The responsible authorities in respect of MAPPA are the police, prison and the probation service and they  have a duty to ensure that a local MAPPA is established and the risk assessment and management of all identified MAPPA offenders is addressed through multi-agency working.

5.16 NHS England 

The general function of NHS England is to promote a comprehensive health service to improve the health outcomes for people in England. NHS England has a statutory requirement to oversee assurance of Integrated Care Boards in their commissioning role.

The mandate from Government sets out a number of objectives which NHS England is legally obliged to pursue. The objectives relevant to safeguarding are:

• continuing to improve safeguarding practice in the NHS;
• contributing to multi-agency family support services for vulnerable and troubled families; and
• contributing to reducing violence, in particular by improving the way the NHS shares information about violent assaults with partners, and supports victims of crime.

They have two distinct safeguarding roles:

1. Direct commissioning: Commissioning primary care, specialised services, health care services in justice, health services for armed forces and families and some public health services. As a commissioner of health services, NHS England also needs to assure itself that the organisations from which it commissions have effective safeguarding arrangements in place.
2. Assurance and system leadership: discharged through the Chief Nursing Officer (CNO) who has a national safeguarding leadership role. The CNO is the Lead Board Director for safeguarding and has a number of forums through which to gain assurance and oversight, particularly through the NHS England National Safeguarding Steering Group

In addition, NHS England is responsible for ensuring, in conjunction with Clinical Leads from North East and North Cumbria ICB, that there are effective arrangements for the employment and development of a named GP/named professional capacity for supporting Primary Care within the local area

5.17 Safeguarding Forum

Integrated Care Boards (ICBs) and NHS England provide support to safeguarding professionals to be able to access the widest possible expertise to support improving safeguarding practice across the NHS system. In order to support this, NHS England have established Safeguarding Forums within each region. For South Tyneside locality this forum is hosted by NHS England Cumbria and North East NHS England.

5.18 Office of the Public Guardian (OPG)

The OPG was established under the Mental Capacity Act 2005 to support the Public Guardian and to protect people lacking capacity by:

• • setting up and managing separate registers of lasting powers of attorney, and of court appointed deputies;
  • supervising deputies;
  • sending Court of Protection visitors to visit individuals who lack capacity and also those for whom it has formal powers to act on their behalf;
  • receiving reports from attorneys acting under lasting powers of attorney and deputies;
  • providing reports to the Court of Protection;

• dealing with complaints about the way in which attorneys or deputies carry out their duties.

The OPG can carry out an investigation into the actions of a deputy, of a registered attorney (lasting powers of attorney or enduring powers of attorney) or someone authorised by the Court of Protection to carry out a transaction for someone who lacks capacity, and report to the Public Guardian or the court.

5.19 Providers

All commissioned service provider organisations should produce their own guidelines that are consistent with the multi-agency Safeguarding Adults policy and procedures. These should set out the responsibilities of staff, clear internal reporting procedures and clear procedures for reporting to the local Safeguarding Adults process. In addition, provider organisations’ internal guidelines should cover:

• a ‘whistleblowing’ policy which sets out assurances and protection for staff to raise concerns;
• how to work within best practice as specified in contracts;
• how to meet the standards in the Health and Social Care Act 2008 (regulated activities) and the Care Quality Commission (Registration) Regulations 2009;
• how to fulfil their legal obligations under statutory processes;
• robust recruitment arrangements;
• training and supervision for staff.

5.20 Public Health 

The UK Health Security Agency is responsible for protecting every member of every community from the impact of infectious diseases, chemical, biological, radiological and nuclear incidents and other health threats. Alongside this, the Office for Health Improvement and Disparities provides a focus on improving the nation’s health so that everyone can expect to live more of life in good health, and on levelling up health disparities to break the link between background and prospects for a healthy life.

5.21 Trading Standards

Trading Standards provide advice for businesses and is responsible for enforcing laws covering the safety, descriptions and pricing of products and services. Trading Standards officers have particular skills in dealing with fraud, tricks and scams

5.22 Voluntary or community sector

The Voluntary and Community Sector (also non-profit sector or ‘not-for-profit’ sector) is the duty of social activity undertaken by non-statutory organisations. The Voluntary and Community Sector should include safeguarding adults within their induction programmes.

Safeguarding should be integral to policies and procedures and policies, for example:

• staff and volunteers are aware of what abuse is and how to spot it;
• having a clear system of reporting concerns as soon as abuse is identified or suspected;
• respond to abuse appropriately respecting confidentiality;
• prevent harm and abuse through rigorous recruitment and interview process.

Voluntary and community organisations can promote safeguarding and support statutory organisations through consultations on policy and developments, work on prevention strategies and promoting wider public awareness. South Tyneside Safeguarding Adults Board has the discretion to invite membership from the voluntary and community sector.

1. Introduction

The Care Act 2014 states that Safeguarding Adult Boards (SABs) must arrange a Safeguarding Adults Review (SAR) when:

• an adult in its area with care and support needs dies as a result of abuse or neglect;
• whether known or suspected; and
• there is concern that partner agencies could have worked more effectively to protect the adult.

SABs must also arrange a SAR if an adult with care and support needs, in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect.

In the context of SARs, something can be considered serious abuse or neglect where, for example the individual was likely to have died but for an intervention, or suffered permanent harm or has reduced mental capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect.

SABs may arrange for a SAR in any other situations involving an adult in its area with care and support needs, whether or not they are being met by the local authority. The SAB may also commission a SAR in other circumstances where it feels it would be useful, including learning from ‘near misses’ and situations where the arrangements worked especially well. The SAB decides when a SAR is necessary, arranges for its conduct and if it so decides, implements the findings.

2. Criteria

The criteria are met when:

• an adult dies (including death by suicide) and abuse or neglect is known or suspected to be a factor in their death; or
• an adult has sustained a potentially life threatening injury through abuse, neglect, serious sexual abuse or sustained serious and permanent impairment of health or development through abuse or neglect; and one of the following:
• where procedures may have failed and the case gives rise to serious concerns about the way in which local professionals and / or services worked together to safeguard adults;
• serious or apparently systematic abuse that takes place in an institution or when multiple abusers are involved. Such reviews are likely to be more complex, on a larger scale and may require more time;
• where circumstances give rise to serious public concern or adverse media interest in relation to an adult.

There is an expectation that individuals, agencies and organisations, cooperate with the review.. However,t the Act also gives the Safeguarding Adults Board (SAB) the power to require information from relevant parties. The SAB may also commission a SAR in other circumstances where it feels this would be useful, including learning from ‘near misses’ and situations where the arrangements worked especially well. The SAB will decide when a SAR is necessary, arrange for its conduct and if it so decides, implement the findings.

3. Criminal Investigations and Police Involvement

Where there is an ongoing criminal investigation or criminal proceedings, the SAB will need to consider, in consultation with the police, whether continuing with the SAR might prejudice their outcome and whether the completion of the SAR should be postponed until after the criminal investigation or proceedings have been completed.

4. Outside of a SAR Remit

Where the Safeguarding Adult Board agrees that a situation does not meet the criteria but agencies will benefit from a review of actions other methodologies may be considered. These include:

• Serious Incident Review: organisations should use their own serious incident procedures if this is deemed suitable and special consideration should be given to the involvement of relevant partner organisation;.
• Management review: a review by an individual organisation in relation to their understanding and management of a particular safeguarding issue;
• Reflective Practice Session: The original participants in the case may review identified aspects of the case as part a reflective practice session chaired by the safeguarding lead or other relevant person, including an independent facilitator;
• Learning Together SCIE: which is a collaborative scrutiny approach to a case review.

5. Principles

SARs will reflect the six adult safeguarding principles and be conducted within a framework of openness and transparency (see Context, Principles and Values chapter, Principles of Adult Safeguarding).

6. Purpose

The purpose of all SARs is to keep the focus on learning. The final SAR report and those responsible for disseminating the learning from it, should ensure that the recommendations can be translated into practice, not just for those involved but to a wider audience to support prevention strategies and influence strategic plans.

It is not for a SAR to investigate how a death or serious incident happened. Neither is it the responsibility of the SAR to apportion blame. Such matters will be dealt with by the Coroner’s or criminal courts, or other bodies.

7. The Adult

In non-fatal cases, the views of the adult should be central to the decision making process about the type of SAR to undertake. Communication should be established at the earliest opportunity and advocacy provided to support the adult. Information should be given about how the SAR will be conducted and how they can be involved or, in the event that the adult has deceased, how nominated people can be involved.

Where there is a police led investigation, close contact with any appointed police Family Liaison Officer should be made. Communication should be clear and consistent between all designated supporters including independent advocates. See Section 3, Criminal Investigations and Police Involvement above in relation to cases where there is an ongoing criminal investigation or criminal proceedings.

8. Person alleged to have caused harm

The emphasis on learning should include the person alleged to have caused abuse or neglect so they can adjust their behaviour, act differently and reflect upon the impact that they might have had on others. This may involve liaison with other professionals, working with, or trained to work with people who abuse.

9. Advocacy

The local authority must arrange, where necessary, for an independent advocate to support and represent an adult who is the subject of a SAR. Where the adult is deceased, it is good practice to provide advocacy to family / friends.

10. Carers

The desired outcome, especially where a family is bereaved, needs to be approached with sensitivity. Consultation and involvement needs to be balanced with the overall wellbeing of the individuals involved. Throughout the process due diligence, compassion and appropriate support should be provided and the relevant local authority community team should be available to provide this or an alternative arranged if more appropriate.

11. Staff

All professionals should be fully involved in reviews and invited to contribute their perspectives without fear of being blamed for actions they took in good faith. Where an adult has died, professionals working with that adult should have the opportunity to discuss their feelings in a safe environment and offered counselling or other therapeutic support. Professional supervision may not be the most helpful means of exploring any fears or anxieties or coping mechanisms to enable professionals to take an objective view and learn from the SAR. There will be occasions when allegations are made that staff have been guilty of abuse against adults.

If the staff member is subject to a criminal investigation, consideration will need to be given to the timing of any SAR (see Section 3, Criminal Investigations and Police Involvement).

If the staff member is subject to a disciplinary enquiry, it is likely that the SAR will work alongside the disciplinary enquiry.

12. Who should undertake a SAR?

The individual commissioned to undertake the SAR should be independent of the organisations involved. They should have the appropriate core skills including:

• strong leadership and ability to motivate others;
• expert facilitation skills and ability to handle multiple perspectives and potentially sensitive and complex group dynamics;
• collaborative problem solving experience and knowledge of participative approaches;
• ability to find and evaluate best practice;
• good analytic skills and ability to manage quantitative and qualitative data;
• knowledge of safeguarding adults;
• ability to write for a wide audience and
• an understanding of the complexity of the health and social care system .

13. Requests

Any individual, agency or professional can request a SAR. This should be made in writing to the Chair of the Safeguarding Adults Board using the agreed referral form contained in Referral Form for a Safeguarding Adult Review. The following information should be included:

• what happened – with dates if known;
• the views of the adult / family / carer;
• where the incident / concerns took place;
• who was involved and their organisation and
• why the request is being made.

The SAR subgroup will consider the request against the criteria in the Care Act in order to ensure the SAR process is consistently applied. Agreement to carry out a SAR should be recorded on relevant systems across the statutory agencies.

14. Commissioning a SAR

The Safeguarding Adults Board is the only body authorised to commission a SAR and decide when a SAR is necessary; arrange for its conduct and if it so decides, to oversee implementation of the findings.

The Safeguarding Adults Board will convene a subgroup to act on its behalf to receive and manage requests, and have delegated commissioning responsibilities. In commissioning a SAR the agreed protocol will be followed (see .South Tyneside Safeguarding Adult Review (SAR) Protocol). 

Whatever arrangements are in place, where there is agreement for a SAR, a SAR chair will be identified to co-ordinate arrangements.

14.1 SAR options

A number of options may be considered by the Safeguarding Adults Board or delegated subgroup. The approach used for the SAR be the most appropriate and proportionate model for the situation. No one model will be applicable for all cases. The focus must be on what needs to happen to achieve understanding, take remedial action and, very often, provide answers for families and friends of adults who have died or been seriously abused or neglected. Every effort should be made while the SAR is in progress to capture points from the case about improvements needed and to take corrective action.

When commissioning a SAR the following points will be agreed:

• scope of the terms of reference;
• knowledge, skills and experience of the reviewer;
• timescales for completion;
• who will secure any legal advice required;
• how the interface between the SAR and any other investigations or reviews will be managed;
• a communication strategy, including clarification about what information can be shared, when and where (conditions);
• a media strategy;
• what the arrangements for administrative and professional support are and
• how it will be paid for.

15. Links with other Reviews and Investigations

For victims of domestic homicide, there is separate statutory guidance in respect of children, which provides for a  Child Safeguarding Practice Review (see also Working Together to Safeguarding Children, gov.uk) and in respect of persons aged 16 or over, which provides for a  Domestic Homicide Review (DHR) (see Multi-agency Statutory Guidance for the Conduct of Domestic Homicide Reviews, Home Office).

These two sets of statutory guidance overlap where the victims are aged between 16 and 18.  When commissioning a SAR there will be consideration of how it how will dovetail with other statutory reviews and any other investigations.

The guidance for DHR states consideration should be given to how the Child Safeguarding Practice Reviews and DHRs can be managed in parallel in the most effective way, so that organisations/professionals can learn from the case. Different types of reviews will have their own specific areas of investigation and these should be respected. Where intelligence can be shared across reviews, there should be no organisational barriers to information sharing. It is also helpful to consider if some aspects of the reviews can be commissioned jointly to reduce duplication.

16. Coroners

Any SAR may need to take account of a Coroners’ inquiry, including disclosure issues, to ensure that relevant information can be shared without incurring significant delay. Coroners are independent judicial officer holders who are responsible for investigating violent, unnatural deaths or deaths of unknown cause, and deaths in custody, or otherwise in state detention, which are reported to them. The Coroner may have specific questions arising from the death of an adult, these include:

• where there is an obvious and serious failing by one or more organisations;
• where there are no obvious failings, but the actions taken by organisations require further exploration/explanation;
• where a death has occurred and there are concerns for others in the same household or other setting (such as a care home);
• deaths that fall outside the requirement to hold an inquest but follow-up enquiries/actions are identified by the Coroner or their officers.

Where the Coroner identifies issues such as these, the SAB will consider whether a SAR is required.

17. Findings from SARs

The findings and outcomes of any SAR will be captured within the Safeguarding Adults Board Annual Report and online (see Local Safeguarding Adult Reviews, South Tyneside Council website)

18. Timetable

The timescale from the decision to conduct a SAR to completion is six months. In the event that the SAR is likely to take longer for example, because of potential prejudice to related court proceedings, the adult/advocate and others will be advised in writing the reasons for the delay and kept updated on progress.