5.1.3 Out of Area Safeguarding Adults Arrangements

1. Introduction

This chapter is based on the protocol for Out-of-Area Safeguarding Adults Arrangements (ADASS) which provides additional guidance for use when responding to safeguarding adults concerns involving cross-boundary issues. It summarises the actions for the host authority, the commissioning authority and service provider at the different stages of a safeguarding enquiry.

Risk and complexity can be increased where care and support arrangements cross local authority boundaries. This includes where the funding or commissioning responsibility for an adult lies with one local authority area but concerns about possible abuse or exploitation are raised in another local authority area.

The ADASS guidance applies to people living at home, in the community and all care and support settings in England, including registered care settings, supported living, community settings, family placement or hospitals. It applies to all adults at risk of abuse or neglect, as defined by section 42 of the Care Act (see The Safeguarding Duty, in Safeguarding: What is it and why does it Matter), whether or not the costs of their care and support are being met by public funds.

Where safeguarding adults concerns are raised, it is the local authority where the risk has been raised that is responsible, under section 42 Care Act 2014, for ensuring that enquiries are undertaken as required.

1.1 Making Safeguarding Personal

Whenever cross boundary safeguarding concerns are identified and being investigated, it is important that the adult remains at the centre of the enquiry; their wishes should be obtained and they should be involved in any safeguarding plan that is developed.

It is not helpful to prescribe single process which must be followed in all cases. There should be coordination between all agencies involved and that timely agreement is reached on what the enquiry will include and how it will be conducted.

For example, if an adult experiences abuse while being in another local authority for a very short time (for example they are on holiday or a day trip in a neighbouring authority), the statutory duty under section 42 remains with the host authority but the commissioning authority should be contacted to discuss who should carry out the enquiry in these circumstances.

See also Making Safeguarding Personal chapter.

1.2 Terminology

The ADASS guidance uses the following terms:

Host authority: The local authority in the area where the alleged risk arose or abuse occurred, and which therefore has the section 42 duty to make enquiries or cause them to be made (whether or not the host authority is commissioning care and support services for the adult).

Commissioning authority: The local authority or NHS Body that is responsible for commissioning care and support services for an adult involved in a safeguarding adults enquiry. Commissioning authorities should notify host authorities of care and support arrangements which have been commissioned in their area (Care and Support Statutory Guidance para 19.56).

2.  Principles for Out of Area Safeguarding Adult Arrangements

The host authority should take overall responsibility for coordinating the safeguarding adults enquiry and ensure there is effective communication between all agencies and professionals involved in the case, including meetings held and planning for any required investigation.

The placing authority should:

• have a continuing duty of care to the adult that they have placed;
• participate in the investigation as required;
• ensure that the provider has arrangements and procedures in place in relation to safeguarding adults and how staff should respond to concerns, which should also link to the local (host) multi-agency safeguarding adults procedures. This should be a requisite of contracting arrangements. This should include the requirement to inform the host authority of any safeguarding concerns.

Authorities may negotiate certain arrangements, for example relating to another authority undertaking assessments, reviews, investigative activities. In such cases, the placing authority would maintain overall responsibility for the adult they placed. Reimbursement for such actions should be discussed and agreed between the authorities, as appropriate.

Providers of care and support services have rights and responsibilities, and also may be required to undertake their own investigations into an adult safeguarding concern. The host authority must ensure effective and timely communication with the provider throughout the investigation (see also Integration, Cooperation and Partnerships).

3. Safeguarding Adults Processes – Roles and Responsibilities of the Host Authority, Commissioning Authority and Service Provider

3.1 When a safeguarding concern is raised

3.1.1 Actions for the host authority

• Inform commissioning authorities as soon as possible of any allegations. This applies equally whether the adult is at risk or has experienced the alleged abuse or is thought to be the source of risk;
• Lead the initial response to the concern in consultation with the commissioning authority. If the concerns involve a person in a position of trust (PiPoT) the Allegations Against People in a Position of Trust Policy should be followed;
• Consider if immediate action is required to protect the adult, for example by contacting the policy or other emergency services. A medical assessment of any injuries or health concerns should be arranged if required (in liaison with the commissioning authority);
• Identify a lead co-ordinator (such as a social worker, nurse or safeguarding manager) to act as the name co-ordinator with overall responsibility for the enquiry;
• Coordinate the enquiry using the principles of Making Safeguarding Personal and begin the process of notifying and gathering information about the concern from other relevant agencies.

If the initial safeguarding plan recommends moving the adult to a place of safety, wherever possible, this should be done following discussions with the adult, their formal representatives, and significant others such as informal carers, family members and the commissioning authority. Funding responsibilities for any such alternative provision will remain with the commissioning authority.

3.1.2 Actions for the commissioning authority

When the commissioning authority is notified of a safeguarding concern they will:

• Contact the host authority to check they are aware of the concern;
• Check the care and support is still appropriate and continues to provide a safe environment to meet the adult ’s needs. This may require a review of the care and support plan;
• Seek an alternative service or accommodation if necessary, whilst ensuring the current provider has made adequate provision for immediate protection and meeting the adult ’s needs until such a move occurs;
• Provide relevant information to the lead coordinator from the host authority.

3.1.3 Actions for service providers

When safeguarding concerns are raised, providers have duties as both service providers and an employer including to:

• deal with employment / disciplinary issue;
• protect adults at risk;
• investigate incidents where required;
• provide assurance to commissioning and regulators;
• prevent recurrence and risk to others including following PiPoT processes if required;
• reporting concerns to host and commissioning authorities.

When a concern is raised, providers should:

• Inform the relevant regulator of any safeguarding concerns which arise for any adults using their support or services;
• Inform the host local authority and the commissioning authority about the concerns and any actions which have already been taken to safeguard the adult(s);
• Consider if any other adults using the service are at risk, and if necessary take action to safeguard these adults;
• Promote an open culture to ensure the best outcome for the adult concerned.

If the concerns involve a person in a position of trust (PiPoT) in the organisation the Allegations Against People in a Position of Trust policy should be followed.

3.2 Undertaking safeguarding enquiries

3.2.1 Seeking the adult’s views and preferred outcomes

The Care and Support Statutory Guidance states that a safeguarding enquiry will usually start with asking the adult their views and wishes and this will often, in turn, determine the next steps. The views and wishes of the adult should be sought at the earliest opportunity. The commissioning authority is likely to have an established relationship with the adult and their family / carers, so may be the most appropriate organisation to ascertain the adult’s views and undertake initial enquiries with them. If an independent advocate is required, the commissioning and host authorities should agree how this will be provided.

Outcomes for the enquiry should be jointly agreed by the adult or their representative in consultation with any advocate, the host authority and the commissioning authority.

Mental capacity and best interests will be central to decision making at this stage. Any assessment of mental capacity which is required will be carried out by a professional from the commissioning authority. Advocacy services would normally be commissioned by the host authority.

3.2.2 Actions for the host authority

• Ensuring the section 42 enquiry is conducted in line with local safeguarding adults policies and procedures. This can include asking another organisation (such as the service provider) to undertake the enquiry on its behalf;
• Arranging a planning discussion or meeting (these can be held online) with commissioning authorities and all other relevant agencies invited to contribute. The planning meeting should:
  • agree roles and responsibilities for undertaking the enquiry – establishing this at the outset is essential if the adult’s wellbeing and desired outcomes are to remain central to the process (overall responsibility for coordinating the enquiry remains with the host authority);
  • clarify expectations including timescales and who is best to undertake the enquiry taking account of geographical distance and other relevant issues;
  • agree a clear communication and engagement plan which covers communication with the adult, families, carers and advocacy services. This plan should be reviewed regularly;
• Keep the commissioning authority and service provider informed; the named lead coordinator will ensure all decisions and agreed actions are fed back to the commissioning authority and the service provider.

3.2.3 Actions for the commissioning authority

• Identify a representative to participate in any planning meetings organised by the host authority;
• Provide all relevant information to the lead coordinator in the host authority;
• Agree actions with the host authority, including whether a mental capacity assessment is required (undertaken by relevant profession from commissioning authority) or provision of independent advocacy (commissioned by host authority).

3.2.4 Actions for the service provider

• Discuss details of the concern with the host authority to decide whether any further actions are required. The host authority may ask (cause) the provider to make enquiries on its behalf (in these circumstances, the host authority retains accountability and oversight of the enquiry and outcomes, and it cannot delegate its lead role in co-ordinating duty of enquiry to the service provider);
• Provide details of commissioning authorities to the host authority so they can liaise with them. Information on any adults at risk who are self-funders should also be provided;
• Look into the concern and involve the adult by asking them or their representative what they would like as an outcome following the raising of the safeguarding concern. Carers or family members should also be consulted. This should be recorded and shared with the host authority as part of the enquiry.

3.3 Completion of the safeguarding enquiry

3.3.1 Actions for host authority

• Arrange a discussion to share the enquiry report(s) with any relevant commissioning authority. The purpose of this discussion to:
  • share the outcome of the enquiry;
  • agree recommendations regarding the outcome of the enquiry, including the extent to which it has been able to achieve the outcomes for the adult, or what more they would like to happen;
  • identify any different views and the potential opportunities to resolve them;
  • agree how communication with the adult, their family, carers or advocate regarding the outcome of the enquiry and content of the report/s will take place, ensuring the adult remains at the centre of the work;
  • agree how the attendance of the adult, their family, carers or advocate at any meetings should be facilitated and / or their views reflected in the outcome;
  • discuss the recommended content of the safeguarding plan where appropriate;
  • agree arrangements for ongoing review of the safeguarding plan.

If a service provider has undertaken the enquiry on behalf of the host authority, they will liaise with the host authority on their findings so that the host authority can decide whether any further actions are required.

3.4 Safeguarding outcomes and outcome meeting

At the end of the section 42 enquiry, the named lead coordinator, adult and others involved in the enquiry should consider:

• whether the adult’s desired outcomes have been achieved;
• the level of remaining risk (if any); and
• if any further actions are required.

If a meeting is arranged to discuss the outcome of the enquiry, the commissioning authority will attend. Where appropriate, the commissioning authority will ensure family members are invited to attend. If family members cannot attend, the commissioning authority is responsible for ensuring their views are obtained.

If the need for an individual safeguarding plan is identified this will be discussed and agreed at the outcome meeting.

3.5 Implementing the safeguarding plan

Following the enquiry, a safeguarding plan may be required to confirm the actions needed and who is responsible for implementing these. A safeguarding plan is not a care and support plan, it will focus only on care provision in relation to the aspects that help to safeguard against abuse or neglect, or which offer a therapeutic or recovery-based resolution.

The safeguarding plan should set out:

• views, wishes and goals of the adult and the level of risk they are comfortable with (where the adult does not have capacity to express this, a decision may be required in their best interests);
• what steps are going to be taken to assure the future safety of the adult, in line with their wishes;
• the provision of any support, treatment or therapy, including ongoing advocacy;
• any changes needed in the way services are provided (e.g. same gender care of placement, request for court appointed deputy);
• how best to support the adult through any action they may want to take to seek justice or redress;
• any ongoing risk management strategy required.

The safeguarding plan should outline the roles and responsibilities of all individuals and agencies involved and identify the lead professional who will monitor and review the plan, and when this will happen. Safeguarding plans should be person-centred and outcome-focused and should be made with the full participation of the adult involved.

Review of the safeguarding plan can be part of ongoing care management, or a specific review of the safeguarding plan may be required. If the safeguarding plan needs to be reviewed, the timescales for this should be agreed by all involved.

If the care setting / provider is allocated any tasks as part of the safeguarding plan, the host authority will be responsible for keeping the commissioning authority and other relevant agencies informed or progress (or any concerns raised).

2.5.1 Actions for the host authority

Provide feedback on progress or concerns to health and social care commissioners and the Care Quality Commission (CQC). Meeting minutes must be shared with the CQC when the allegations involve a regulated service, even if CQC has not been represented at the outcome discussion.

3.5.2 Actions for the commissioning authority

Notify the host authority of the completion of any protection actions agreed. Ongoing protection planning and review of safeguarding plans for each adult is the responsibility of their commissioning authority.

3.5.2 Actions for the service provider

Participate in future meetings in line with local multi-agency procedures, to review whether the desired outcomes of the adult at risk have been achieved, whether the safeguarding plans are working and whether any further actions are required.

4. Transitional Arrangements – Safeguarding Children and Younger Adults

4.1 Incident occurred prior to the young person’s 18th birthday

When the person who is alleged to have been abused or harmed is over the age of 18 years by the time the safeguarding incident is reported, but the incident occurred prior to the young person reaching 18 years, any investigation into the concern will be led by Children’s Social Care in the area where the individual was physically present (the host authority) at the time of the incident, in partnership with Adults Safeguarding services.

This is of particular importance when the abuse or harm is ongoing, for example, when the individual is experiencing sexual or criminal exploitation or self-neglect, as it is likely that the safeguarding plan will need to be delivered by adult services.

4.2 Incident occurred after the young person was 18

When the person is over 18 and the alleged incident occurred after they were 18, the duty to carry out any investigation into the concern will be held by the host local authority’s Adults Safeguarding team, regardless of which local authority was providing services to them as a child. However, any children’s services that have been involved recently (even if their support has ended) should be invited to contribute to the enquiry, to ensure good quality information sharing.

Where someone is over 18 but still receiving children’s services and a safeguarding issue is raised, the matter should be dealt with as a matter of course by the adult safeguarding team. When the younger adult is 18-25 and is being supported by the commissioning authority children’s services (e.g., SEND or leaving care) it is critical that there is communication, information sharing and joint working with the host authority’s safeguarding adults’ services.

5. Resolving Disputes

Professional disagreements should be resolved at the earliest opportunity in line with the Escalation and Challenge Protocol.

6. Organisational Abuse Enquiries

When a number of individual safeguarding enquiries are raised in relation to the same place, or within the same organisation, this can be a sign of wider organisational concerns about poor quality care or indicate the need for further review.

When such safeguarding adults concerns involve a number of different adults who are at risk of abuse or harm, and a number of different commissioning authorities, the task of coordinating the enquiry becomes much more complex.

Organisational abuse is distinct from other forms of abuse or neglect because it is not directly caused by individual action or inaction. Instead, it is a cumulative consequence of how services are managed, led and funded. This also therefore means that there is no on size fits all approach for managing and responding to organisational approach.

Enquiries into organisational abuse can have wide strategic implications, and a carefully managed response is needed to ensure effective, timely and responsive actions. The process must be supported by a comprehensive communications plan providing detail on how communication will be managed at every stage of the process, including communication with the media.

When a host authority identifies that the degree, complexity and severity of safeguarding concerns indicate that an organisational enquiry is required, it should set up a strategic management group.

Commissioning authorities should be invited to identify the most appropriate senior manager to represent their organisation at the strategic management group and take responsibility for any required actions. Membership can be extended to other key strategic bodies involved or to other advisers or independent persons, such as:

• Care Quality Commission;
• Health and Safety Executive;
• Trading Standards;
• Police;
• Legal adviser;
• Specialist adviser with expertise pertaining to the type of service under investigation;
• Press and communications adviser.

The Strategic Management Group will be responsible for:

• establishing and maintaining a complete picture of the concerns, overseeing strategic risk assessment and management, including decisions on escalation as required (including to a ministerial level);
• implementing a communications plan, with particular reference to service users, families, senior managers, politicians, staff, regulators and the media;
• overseeing the enquiry and make decisions on resources needed to support it, including a decision about whether a dedicated multi-agency team is required;
• reviewing the strategic commissioning impact;
• ensuring that each authority fulfils its role and responsibilities as required (it is worth noting that the host authority may not have any contractual arrangements with the care setting in question);
• making decisions as to what and when information should be shared with other agencies and individuals who are not directly involved or affected by the enquiry;
• taking account of the collective impact on individuals affected and those that remain within the care setting;
• Making strategic links to other organisations, such as ADASS, ADCS, ACPO, as appropriate;
• Agreeing closure of the enquiry, including how lessons learned should be shared.

7. Further Information

7.1 Related chapters

Making Safeguarding Personal

Safeguarding – What is it and why does it Matter?

Escalation and Challenge Protocol