Learning from safeguarding adult reviews (SARs) has highlighted the need for staff across all agencies to have a clear understanding about their responsibility for professional challenge and to know how to escalate concerns about decisions made where there are concerns about the welfare and safety of an adult at risk.
This protocol has been developed with the aim of supporting positive resolution of professional difference between agencies working with adults and their families in South Tyneside. Whilst there is generally a good working relationship between agencies and professional difference can be a driving force in developing practice, occasionally disagreements may arise which requires timely resolution so as not to delay decision making.
This guidance is aimed at colleagues across all services and agencies working with 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 that an adult at risk is safeguarded. The adult’s welfare and safety must remain a priority. Any unresolved issues between professionals should therefore be escalated on the same working day with due consideration to the risks that might exist for the adult.
This protocol must be read in conjunction with the Safeguarding Adults Thresholds Guidance .This provides partner agencies with clear criteria for taking action and providing the right help at the right time to adults at risk in order to effectively meet their needs. If the matter is related to a disagreement within a single agency then this must be addressed within that gency using their protocols.
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 an adult’s safety and well-being. In such cases, reference should be made to the Person / People in Positions of Trust (PIPOT) – Multi-Agency Practice Guidance.
2. Areas of Possible Dissent
There is a range of situations in which professional disagreements may occur. Examples are given below although this list is not exhaustive.
Disagreements can arise in a number of areas, but are most likely to arise around thresholds, roles and responsibilities, the need for action and communication. Some examples may include:
- the referral is deemed not to meet the eligibility criteria for assessment;
- Adult Social Care conclude that further information should be sought by the referrer before a referral is progressed;
- there is disagreement as to whether adult safeguarding procedures should be invoked;
- partners place different interpretations on the need for a single / joint response;
- there is disagreement over the sharing of information and /or provision of services;
- disagreements over the outcome of any enquiry or concern raised and whether the appropriate plan is in place to safeguard and promote the welfare of an adult at risk.
3. Key Principles
The safety of the adult at risk 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.
The best way of resolving difference is through open and transparent discussion and 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 adult. Email 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. It should be acknowledged that differences in status and/or experience may affect the confidence of some workers to pursue this unsupported.
The safety of an adult at risk must not be compromised by using the escalation process (see Section 5, Escalation Process). In most cases it is expected that the matter will be resolved by partners escalating the matter with managers or supervisors the same day. If the matter is escalated to the South Tyneside Safeguarding Adults Board (SAB) representative and finally to the SAB Manager, this process should still be completed and resolved the same day.
If the matter takes longer than a day to resolve, the reasons for this should be recorded with the agency escalating the matter. The manager for that agency must ensure that the safety of an adult at risk has not been compromised by the delay.
It is expected that all issues will be resolved within a maximum of five working days
5. Escalation Process
5.2 Stage 1
If professionals are unable to reach agreement about the way forward in an individual case, their disagreement must be addressed by more senior staff. In most cases this will mean the first line managers within the relevant organisations. Records of discussions must be maintained by all agencies involved. The outcome of discussions and agreed actions should also be recorded.
5.2 Stage 2
If the concern continues the line managers should, without delay, refer to a head of service or equivalent and further discussions should take place with appropriate agencies. In exceptional circumstances the meeting may involve the chair or vice chair of the Safeguarding Adults Board to discuss the situation involves all parties.
Contemporaneous written records must be kept of all discussions and these should be retained on the 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.
It may also be useful for individuals to debrief following some disputes in order to promote continuing good working relationships, identify possible training needs or gaps in policies and procedures.
Appendix 1: Escalation Process Flowchart
Note: At no time must professional disagreement detract from ensuring an adult at risk is safeguarded – the adult’s welfare and safety must remain the paramount concern throughout. Any resolved issues between workers should therefore be escalated on the same working day with due consideration to the risks that might exist for the adult at risk.
Click here to view the Escalation Process Flowchart