Our safeguarding adults work is an important part of our work in Adult Social Care. The aim of this policy is to set the direction for our safeguarding adults work.
Purpose, context and objective
The purpose and objective of this policy is that, by setting the direction of our safeguarding adults work, we will do better at:
- Promoting the wellbeing of people in Surrey who have care and support needs and are experiencing or at risk of abuse and neglect
- Reducing the risks that they face
- Responding when concerns arise in ways that the person with care and support needs finds useful, and which do what is needed to meet the aims of securing justice, promoting recovery and preventing reoccurrence
The context for this policy is:
- The Care Act 2014, the Care and Support Statutory Guidance, and the associated regulations: These create the legal framework for safeguarding adults work, within which this policy must operate. In particular, the statutory guidance has expectations of what must be covered in the policies and processes of all partners involved in safeguarding adults work, and some requirements for local authorities regarding their decision-making role in safeguarding enquiries
- Making Safeguarding Personal: A sector-led improvement initiative which emphasises that safeguarding adults enquiries and reviews must be keep the adult with care and support needs at the centre and in control as much as possible. Making Safeguarding Personal says that important measures of the effectiveness of enquiries and reviews is how well they done in finding out what outcomes the person wants, and then meeting these outcomes
- Surrey Safeguarding Adults Board: The Board sets the local context and will place expectations on the Council and others, and its policies and procedures set the context this policy and procedure.
This policy and its associated procedure and guidance avoids repeating what is in these other documents unless it is required here for clarity. It is assumed that readers of this policy and procedure have made themselves familiar with these other documents.
Adult safeguarding and Adult Social Care
Adult Social Care will not tolerate the abuse of adults with care and support needs. It is committed to promoting wellbeing, preventing harm and responding effectively if concerns are raised.
Adult Social Care is committed to the aims of adult safeguarding:
- prevent harm and reduce the risk of abuse or neglect to adults with care and support needs
- stop abuse or neglect wherever possible
- safeguard adults in a way that supports them in making choices and having control about how they want to live
- promote an approach that concentrates on improving life for the adults concerned
- raise public awareness so that communities, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect
- provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or well-being of an adult
- address what has caused the abuse or neglect.
To contribute to meeting these aims, we will:
- Manage our services in a way which minimises the risk of abuse occurring
- Work with adults with care and support needs and other agencies to end any abuse that is taking place.
To achieve these aims we will:
- Ensure that all managers, employees and volunteers have access to and are familiar with this safeguarding adult policy and procedure and their responsibilities within it
- Ensure concerns or allegations of abuse are always taken seriously
- Ensure the Mental Capacity Act 2005 is used to make decisions on behalf of those adults at risk who are unable to make particular decisions for themselves.
- Ensure all staff receive training in relation safeguarding adults at a level relevant to their role.
- Ensure that people using our services, and where relevant their relatives and their friends, have access to information about how to report concerns or allegations of abuse.
- Ensure there is a named lead person to promote adult safeguarding awareness and practice within the organisation.
This policy and procedure has been developed to be consistent with the Surrey Safeguarding Adults Board Adult Safeguarding Policy and Procedures.
This policy and procedure is guided by the following principles:
The Government's six principles for safeguarding adults
Making Safeguarding Personal
Making Safeguarding Person (MSP) is a sector-led improvement programme which promotes a shift in adult safeguarding practice from a focus on process to a focus on working with people experiencing abuse or neglect to achieving the outcomes that have meaning for them. This involves:
- Developing a real understanding of what people wish to achieve,
- Agreeing, negotiating and recording their desired outcomes,
- Working out with them (and their representatives or advocates if they lack capacity) how best those outcomes might be realised; and the
- Seeing, at the end, the extent to which desired outcomes have been realised.
Human Rights Act
- Article 2: Right to life
- Article 3: No one shall be subjected to torture or to inhuman or degrading treatment or punishment.
- Article 4: Prohibition of slavery and forced labour
- Article 5: No one shall be deprived of his liberty save, in accordance with a procedure prescribed by law
- Article 8: Right to respect for private and family life.
Mental Capacity Act principles
- A person must be assumed to have capacity unless it is established that they lack capacity.
- A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.
- A person is not to be treated as unable to make a decision merely because he makes an unwise decision.
- An act done or decision made under this Act for or on behalf of a person who lacks capacity must be done, or made, in his best interests.
- Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action.
The Public Sector Equalities Duty
The Equality Act 2010 created an Equalities Duty on public bodies.
We will, when carrying out our day-to-day work with all people who may have impaired capacity to make decisions and their families and others in their lives:
- have due regard to the need to eliminate discrimination
- advance equality of opportunity
- foster good relations between different people when carrying out their activities.
The procedures and any guidance that accompany this policy will set out ways of working that will incorporate these elements.
Natural justice and adult safeguarding
Natural justice is a term in law for the rule against bias. It is part of a general duty to act fairly. There are two key principles to natural justice:
- No-one should be judge in their own cause: There should be no actual bias, or the appearance of possible bias. This is sometimes summed up as "Justice must not only be done, but must be seen to be done"
- Hear the other party too: No-one should be judged without a fair process, in which they get to hear and respond to the evidence against them.
Holding ourselves to the same standard
Adult safeguarding concerns will sometimes be about what we in Adult Social Care have or have not done. When this is the case we hold ourselves accountable in our adult safeguarding work in the same way that we hold others accountable. We recognise that this can be difficult for our staff and the Adult Social Care Leadership Team (ALT) is committed to supporting them to do this well.
What we will do to put this policy in to practice
Each year ALT will agree a Safeguarding Strategy, setting out what we will do to take forward our safeguarding work, and to contribute to Surrey Safeguarding Adults Board's Strategic Plan for the year. Where practical, we will set out a strategy for a period longer than a year, as the discretion of ALT.
Surrey Safeguarding Adults Board
We shall be an active member of Surrey Safeguarding Adults Board, and we will ensure that we offer the Board meaningful assurance of our adult safeguarding work.
Good Practice Guidance
We will produce for our staff Good Practice Guidance to support them with putting this policy and procedure in to practice. It will be maintained by the Head of Adult Safeguarding.
We will support our staff to understand our adult safeguarding work, what is going well, what can be improved, and what risk issues we need to pay attention to through regular performance reporting throughout the organisation and to ALT.
We will check that our adult safeguarding work meets our expectations by carrying out quality assurance of that work. This will be led by the Head of Adult Safeguarding.
ALT will promote a culture of learning and continuous improvement around adult safeguarding, which will involve:
- Ensuring adult safeguarding concerns are recognised and acted on
- Adult safeguarding enquiries are effective and get to the point of what has happened and why when things go wrong
- We take action with what we have learned, and help others to do so, in order to promote continuous improvement
- Where things have gone wrong we will support adults with care and support needs, and their families and friends, to get the resolution they need.
Open-mindedness and adult safeguarding
We approach our adult safeguarding work with the aim of being open minded, by which we mean:
- being genuinely concerned to avoid bias, wishful thinking, and other factors, that threaten to compromise a serious examination of the evidence
- being ready to view one's conclusions, no matter how strongly supported, as potentially revisable in the light of further evidence given the fallible nature of knowledge.
At the root of this is a recognition that if we are to do what we should to protect and support adults with care and support needs who are at risk of abuse or neglect requires us to have a genuine desire to know and understand the circumstances around that person and what they have experienced.
The expectation on our staff is that in carrying out adult safeguarding work they are prepared to do their best to establish whether or not there is are grounds for the adult safeguarding concern, and they will do this in an open-minded way which involves:
- Taking account of any relevant evidence;
- Making the best judgements and decisions that we can using that evidence, applying relevant and up-to-date knowledge as needed, and doing so in ways that minimise the impact of bias and errors in decision making;
- Accepting when an unwelcome conclusion follows from that evidence; and
- Allowing that when new evidence requires it, we will change our position.
Responding to difficult issues arising from adult safeguarding work
The Adult Social Care Leadership Team (ALT) recognise that open-minded adult safeguarding work will sometimes involve reaching conclusions that are difficult for the people or organisations involved, and sometimes that will include our own organisation. ALT is committed to:
- Leading an open and ethical culture that encourages open dialogue about concerns
- Ensuring our staff have the training and support they need to raise concerns
- Ensuring that concerns are acted upon.
In some circumstances our staff may wish to make use of the County Council's Whistleblowing Policy. ALT are committed to having an open culture with the aim that issues are dealt with effectively so that the Whistleblowing policy needs to be used as infrequently as possible, but we recognise that sometimes it will be needed and we will support our staff who make use of it.
Material in this section has been drawn from Willam Hare, "Helping Open-Mindedness to Flourish" Journal of Thought 47(2001)
Expectations on our staff
Anyone who may come in to contact with adults with care and support needs, whether in a volunteer or paid role, must understand their own role and responsibilities regarding adult safeguarding:
- As well as this Policy and Procedure, they must be aware of the Surrey Safeguarding Adults Board Adult Safeguarding Policy and Procedures
- They must keep their knowledge and skills up to date by meeting the training requirements expected of their role
- They must understand what is expected of them if they become aware that an adult with care and support needs is experiencing or is at risk of abuse or neglect
- They must take all reasonable actions in line with those expectations
- They must take all reasonable actions to prevent adults with care and support needs from experiencing abuse and neglect.
Expectations on managers
In addition to the above, managers of volunteers and staff must:
- Ensure the people they manage are made aware of the expectations on them regarding adult safeguarding issues
- Have access to the support they need in order to meet those expectations.
Assessment of care and support needs and adult safeguarding work
There is a close relationship between enquiries made under s42 Care Act and assessments of care and support needs under s9 Care Act:
- They involve the same people. S9 Care Act applies "where it appears to the local authority that an adult may have needs for care and support". S42 Care Act "applies where a local authority has reasonable cause to suspect that an adult has needs for care and support". The difference, if any, between "appears" and "reasonable cause to suspect" is so small that in practice these can be taken to by synonymous. It can safely be assumed that anyone that may come within the remit of s42 Care Act will also potentially fall within the scope of s9 Care Act.
- Paragraph 14.94 of the Care and Support statutory guidance says that one of the objectives of an adult safeguarding enquiry is to "assess the needs of the adult for protection, support and redress and how they might be met". As s42 Care Act says adult safeguarding enquires must be made but it does not create any duties, powers or processes for how this is to be done, we must look elsewhere for those. As this objective involves assessing the needs of an adult with care and support needs, it is likely that the way to achieve this objective will often be through an assessment under s9 Care Act.
A difference between the two duties is that for the same person two different local authorities may have different duties. For s42 Care Act, the relevant local authority is where the person is when the abuse happened or the risk of it arose. For s9 Care Act the relevant local authority is where the person has Ordinary Residence.
Refusal of assessment: Section 11 Care Act and adult safeguarding
The close relationship between adult safeguarding enquiries and assessment of care and support needs was built into the Care Act, and this can be seen in s11 Care Act, which is to do with people being able to refuse an assessment.
Much of the time it makes sense for people to be able to refuse an assessment, as otherwise there is the potential for the state to compromise people's rights. But s11 Care Act says people cannot refuse an assessment under s9 Care Act, and the local authority must carry out that assessment, when a person who s9 Care Act applies to either:
- Lacks capacity to refuse the assessment and the local authority is satisfied that carrying out the assessment would be in their best interests; or
- The person is experiencing, or is at risk of, abuse or neglect
This means that for anyone that a local authority has a duty under s42 Care Act to have an adult safeguarding enquiry
- The local authority where that person is ordinarily resident may have a duty to assess their care and support needs; and
- The person is excluded from being able to refuse that assessment under s11 Care Act, and the local authority must carry out that assessment
There will also be people that s9 and s11(2)(b) Care Act apply to, so an assessment of care and support needs must be carried out, but who s42 Care Act does not apply to so there will not be an adult safeguarding enquiry. These will be people who:
- May have needs for care and support;
- Are experiencing, or are at risk of, abuse or neglect; and
- They can protect themselves from that risk of abuse or neglect despite their care and support needs.
Why does the Care Act say this?
During the Committee Stage when the Care Bill was being considered by Parliament, the Minister for Social Care, Norman Lamb, said "These exclusions provide an important safety net to ensure that vulnerable members of society are fully assessed and, if necessary, provided with the appropriate care and support."
S11(2)(b) Care Act is intended to address the problem identified in cases such as Steven Hoskin in Cornwall and Margaret Panting in Sheffield where local authorities avoided or minimised their involvement in situations where an adult with care and support needs was experiencing abuse with, in those cases, fatal consequences.
Sometimes we will have to undertake s42 Care Act enquiries and /or s9 Care Act assessments where the person is uninterested or actively opposed to us doing so. Carrying out that work in those circumstances and trying to get an understanding of what someone's needs are or what risks they are facing can be difficult.
Carrying out assessments when people would want to refuse them can appear, on the face of it, to run contrary to one of the aims in developing our strengths-based approach, which is to avoid people going through unnecessary assessments. There is no actual conflict between that approach and what s11 Care Act requires of us, though, as:
- Our strengths-based working model has always emphasised that we apply it within the legal frameworks for social care. Where there is a non-negotiable duty under s11(2)(a) or (b) to carry out an assessment, then that is what we need to do;
- It has also emphasised that an assessment of care and support needs is about more than being a gateway to a package of care. It is about relationship-based working with the aim of helping people live fulfilling lives. Where there is a concern about abuse and neglect of a person with care and support needs, an assessment can play an important role in understanding what those needs are and how they impact on the risks facing the person.
Having to impose assessments on people might appear to be, and sometimes will be, at odds with the values we would usually expect to apply in our work. But it was clearly the government's intention that this is what is to be done. They reached the view that the drawbacks were outweighed by the advantages of local authorities giving people at risk of abuse and neglect a chance to engage with them. In such cases, we need to put our values in to practice in deciding how we are going to do this work, not in deciding whether we are going to do it.
Do all adult safeguarding enquiries have to involve carrying out a s9 Care Act assessment?
Not necessarily. There will be of cases where we will be able to say that we have an existing assessment, and possibly care and support plan, and we can say that we have complied with s11(2)(b) through either:
- Reassessment under s27(4) Care Act
- Review of care and support plan under s27(2) Care Act
- Being able to say that we are confident that the existing assessment and care & support plan address how the care and support needs impact on any needs of the adult for protection, support and redress and how they might be met, so neither s27(2) or (4) are triggered.
We should record in our adult safeguarding enquiry the decision we have made and the rationale for it about whether there will be a s9 Care Act assessment, reassessment or a s27 Care Act review of a care and support plan.
What s11(2)(b) of the Care Act requires us to avoid doing is having situations where:
- We have carried out a s42 Care Act enquiry of the person and have never carried out a s9 Care Act assessment for that person; or
- We have carried out a s42 Care Act enquiry of the person, there has been a previous assessment for that person, and possible a care and support plan, and we have not revisited these but we have not recorded our decision not to review or reassess and the rationale for it.
Putting this into practice
How do we complete an assessment for someone who is not cooperating?
You may not be able to complete the assessment in the same way as you would expect when working with someone who wants an assessment.
Paragraph 6.21 of the Care and Support statutory guidance say:
"Where the adult who is or is at risk of abuse or neglect has capacity and is still refusing an assessment, local authorities must undertake an assessment so far as possible and document this."
It might be that in some cases "so far as possible" might not be very far at all. If we have made reasonable best efforts then that is not only OK, but it is in line with the principle of proportionality, one of the six principles that the Care and Support statutory guidance says underpins all adult safeguarding work.
How can we establish what needs a person has if they are not co-operating?
Again, you might not be able to do this in the same way as you would expect when working with someone who wants an assessment. If the lack of cooperation from the person means you have not been able to evidence that the person has care and support needs, or that any care and support needs they have are eligible needs, then you might reasonably conclude that your assessment has not established that the person has eligible care and support needs. It may be useful to refer in your assessment to the lack of the cooperation of the person.
What is the role of multi-agency working when someone is not co-operating?
An advantage of working within the framework of s9 Care Act when someone is not cooperating, particularly if they fall outside the remit of s42 Care Act, is that it creates a statutory gateway that can enable others to share information with us. Without this it may be difficult for us to demonstrate that we have a reasonable purpose for having that information.
This does not guarantee that others will share information with us. They would have to go through their usual decision-making on this. They would need to take account of:
- The lack of consent or agreement from the person to the information sharing
- That our request is related to a statutory function
- Whether there are issues such as vital interests or public interests that they should to take account of when deciding what, if any, information to share.
We can help them to make sound decisions about what information to share with us by giving them clear information about the nature of the abuse or neglect that is giving cause for concern and about our understanding of the risks involved, and what processes we are using to respond to those concerns.
Roles in adult safeguarding enquiries
Safeguarding adult enquiries will often involve collaboration by a significant number of people who may be in several different organisations. It can be helpful to have a shared language to describe who does what. Surrey Safeguarding Adults Board has adopted the following terms to describe key roles in adult safeguarding enquiries where Surrey County Council has the duty under section 42 of the Care Act.
These terms relate to roles in an enquiry and are not job titles.
Safeguarding Adults Enquiry Decision Maker ('SAD')
This is the person with responsibility for making the decisions required by s42 Care Act on behalf of the local authority, which are:
- Is there a duty to have an enquiry?
- What will the enquiry consist of?
- Has the enquiry been completed?
- In light of the enquiry what actions, if any, are required and who by?
There is only one person in the SAD role at any one time, though the role may pass from one person to another as the work progresses.
Safeguarding Adults Enquiry Manager ('SAM')
This is the person who carries out day-to-day management of the adult safeguarding enquiry. This will include:
- Allocating resources to enquiry
- Ensuring communication takes place and feedback is given at the end of an enquiry
- One person can act as both SAD and SAM
- In some contexts there may be an expectation that different people hold the SAD and SAM roles.
- In other settings a decision will be made case-by-case whether to have separate SAD and SAM. Indictors of when this might be useful include; 1, Where the concern relates to operational work in sphere of SAM's responsibilities, and a degree of independent oversight may be required. 2, Where there are risks or issues which make it useful to escalate the seniority of the person in the SAD role. 3, If the SAD and SAM roles are held by different people
- The SAM will escalate to SAD at the key points where a decision is required that falls within section 42 of the Care Act
- At those times, the SAM will make a recommendation to SAD on the decision.
There is only one person in the SAM role at any one time, though the role may pass from one person to another as the work progresses.
Lead Enquiry Officer ('LEO')
The Lead Enquiry Officer leads the carrying out of an adult safeguarding enquiry. Their tasks in this are:
- Applying "Making Safeguarding Personal" objectives
- Ensuring communication happens
- Implement enquiry plan
- Coordinate contributions from others
- Produce an enquiry report that brings together information from all sources and makes judgements and recommendations on the questions; 1, Has there been abuse and neglect, or clear risk of these? 2, If so, why? This will include root cause analysis. 3, What actions may be needed?
- Ensuring there is appropriate record of the enquiry.
There is only one person in the LEO role at any one time, though the role may pass from one person to another as the work progresses.
Safeguarding Adults Enquiry Contributor(s) ('SAEC')
This term refers to all people who contribute to Safeguarding Adults Enquiry from a range of organisations, they will:
- Provide the LEO with support and information in line with the enquiry plan
- Makes use of expertise to provide LEO with planning the enquiry and with analysis, judgements and recommendations
- Ensures their own agency or service cooperates with the enquiry
- Ensures their own agency or service acts on the enquiry findings
Who takes on these roles?
Whether a particular individual takes on a particular piece of work will be a local decision within the line management and supervisory relationships.
Factors that would be relevant in this decision may include:
- The usual expectations on the job role
- The experience, knowledge, and skills of the individual worker, which may include their training history
- The developmental goals of the person and the support available to meet these
- Whether there are capability issues that the worker and their manager are addressing
- Whether previous knowledge of and relationship with the adult or other persons involved might mean the worker is either better or worse placed than others to take on the work
- Other demands on the worker
- The needs of the service.
Because of these links between assessment under s9 Care Act 2014 and adult safeguarding enquiries under s42 Care Act 2014, the presumption of Surrey County Council Adult Social Care is that those whose roles involve carrying out assessments under s9 Care Act may have significant involvement in adult safeguarding enquiries, in particular in carrying out the SAEC and LEO roles. This will be subject in any individual case to that staff member having had the appropriate support, learning opportunities and so on needed to promote competence to do so.
Typical roles in ASC
No definition is offered here of low, medium or high risk, and they can be taken to have their usual everyday meaning. Nor is this meant to imply that these roles are only restricted to these job titles. The aim is simply to aid the making of professional judgments case-by-case, not to create a prescriptive model.
|Level of risk||SAD||SAM||LEO||SAEC|
|Low risk||ATM||ATM or Safeguarding Advisor||Social worker / OT / Senior Social Care Assistant||As required|
|Medium risk||TM||ATM or Safeguarding Advisor||Social worker / OT / Senior Social Care Assistant||As required|
|High risk||Senior Locality Manager||Team Manager||ATM / Social Worker / Safeguarding Advisor||Adult Safeguarding Leads for the organisations involved|
The role of Safeguarding Adults Advisors
There are Safeguarding Adults Advisors in most case-holding teams in Adult Social Care in Surrey County Council, and in the integrated Adults Mental Health Services. These roles are locally managed but have a County-wide element to their work.
To reflect this, Adult Social Care has set out the types of work it expects Safeguarding Adults Advisors to be involved in, and the priorities we attach to these as a business, and it is for local arrangements to apply this hierarchy of priorities in the local context.
Areas of work in priority order
- Quality Assurance Auditing of adult safeguarding enquiries
- Learning and development role
- Line management for staff with specialised adult safeguarding roles
- Leadership across the local adult safeguarding system including: a. Being a source of expert advice and guidance on adult safeguarding locally, b. Representing Adult Social Care at area based multi-agency forums
- Representing Adult Social Care at County wide multi-agency forums
- Links with Children's Social Care
- Links with community safety
- Operational involvement in adult safeguarding work
- Line management for staff without specialised adult safeguarding roles
- Operational involvement in non-adult safeguarding work.
Problem resolution process
ASC Leadership Team agreed the set of priorities above for the work of Safeguarding Adults Advisors, which should inform local decision making about the particular work each Advisor will undertake. It is possible that different views might be held about how the priorities should be applied locally. At the end, this is a line management issue and can be addressed through the usual processes. What is set out here is a supplemental process which reflects that this is an issue with multiple stakeholders, and it can be useful to ensure the range of relevant issues is informing decision making.
Set out below is a sequence of steps to be taken should differences in views arise, until the issue is resolved. It is set out here to address a difference in views between the Advisor and the Locality Team Manager who is their line manager, but the principles can be applied in other circumstances:
- Discussions between the Advisor and the Team Manager to explore the differences in views and seek resolution
- The Team Manager seeks advise from the Head of Adult Safeguarding
- The Team Manager seeks advise from another Locality Team Manager
- The Team Manager seeks advise from the Locality Senior Manager
- The Team Manager gives instruction as to the local priorities that will be applied.
The role of the MASH in adult safeguarding work
The Surrey Multi-Agency Safeguarding Hub for adults is the main referral point for adult safeguarding concerns. This is where partner organisations and the public are advised to refer adult safeguarding concerns.
The aims of the MASH are:
- To enable good decision making by Surrey County Council, in partnership with other agencies, about when an adult safeguarding concern will lead to an adult safeguarding enquiry;
- To enable good decision making by Surrey County Council, in partnership with other agencies, about what will be involved in carrying out an adult safeguarding enquiry
- To enable good information sharing practice across the partner agencies so that there is a shared understanding of the circumstances and the risk in situations where there is an adult safeguarding concern or enquiry
In addition to handling adult safeguarding concerns referred to it,
- The MASH can support teams receiving adult safeguarding concern referrals arriving by other routes, or which emerge in the course of work they are doing, by carrying out a round of information sharing among the MASH partners and providing this to the team handling the referral
- The MASH can also be used by teams undertaking adult safeguarding enquiries to get an up-to-date information from the MASH partners in regard to the situation relating to any particular enquiry.
Which decisions will the MASH make?
For the adult safeguarding concerns that are referred to it, the decision on behalf of the local authority whether the tests in s42 Care Act have been met will be made within the MASH.
This will ensure that any information sharing between partners at the MASH will take place either:
- For the purposes of the local authority deciding if the tests in s42 Care Act 2014 have been met, and the information shared will be proportionate to that decision; or
- For the purposes of making decisions under s42 Care Act 2014 as to what enquires are necessary and / or whether any action should be taken and if so, what and by whom
If the purpose of the information sharing is for an adult safeguarding enquiry then the decision that the tests in s42 of the Care Act have been met is made before requests for information sharing are made.
Adult Safeguarding in integrated teams
Section 79 of the Care Act 2014 places restrictions on which powers and duties in that Act local authorities can delegate to others. The adult safeguarding duties and powers under sections 42 to 47 of the Care Act 2014 are restricted.
Paragraph 18.5 of the Care and Support Statutory Guidance says:
"The power to delegate functions in the Care Act does not supersede the pre-existing ability for NHS and local authorities to enter into prescribed partnership arrangements under Section 75 NHS Act 2006. This means that local authorities can enter into partnership arrangements with the NHS for the NHS to carry out a local authority's 'health-related functions'. This includes authorisation for NHS bodies to exercise those health-related functions, including safeguarding functions, that local authorities are prohibited from delegating under the Care Act."
This means that:
- Adult safeguarding functions can be delegated by Surrey County Council to an NHS body, if there is an arrangement in place under section 75 NHS Act 2006 that enables this
- Where there is such an agreement in place, whether it is put in to operation at any given time, is a decision made at the discretion of Surrey County Council or is subject to agreement between Surrey County Council and the relevant NHS partner(s)
In integrated teams and other services where there may be delegation of adult safeguarding functions:
- It will be a decision for the management of that service whether to exercise their discretion to delegate those functions at any given time
- It will be for the management of that service to negotiate with the relevant NHS partner(s) how this will be done
- Whether the adult safeguarding functions are being delegated or not, the management of that service will set out the local arrangements for their adult safeguarding work. This will be in whatever form meets the needs of the situation, such as guidance, protocols or a memorandum of understanding.
Adult safeguarding concerns regarding our staff or services
There will be adult safeguarding concerns where our own staff or organisation is the source of risk. Decisions will be made case-by-case about how the response to these will be managed. These decisions will be informed by these starting points:
- The safety of the adult is of paramount importance.
- Immediate action may be required to safeguard the adult, and any other children, young people or adults at risk.
- Any concern that adults may be at risk of harm or abuse, must immediately be reported. Public confidence or reputational issues must be managed appropriately by discussion with senior managers. There may be a role for the communications team.
- The concern should also be reported to the staff member's line manager
- Any action taken to manage an allegation must not jeopardise any external investigations, such as a criminal investigation.
- It is essential that every effort must be made to maintain confidentiality and manage communications while an allegation is being investigated.
- Where there is a possible crime the SAD / SAM will ensure there are discussions with the police to identify which agency will be leading on the investigation.
- The SAD / SAM and the person's line manager should seek advice from HR department on the action to be taken in relation to the employee. The staff member's line manager may need to consider whether suspension is appropriate
- The Line Manager should ensure there is appropriate support to the individual while the case is on-going and keep them regularly informed.
- Further support may be considered necessary from Occupational Health.
- The Planning of the enquiry.
The Planning of the enquiry should consider:
- How the adult at risk of harm or abuse, or their representative, and the person making the allegation are to be kept informed of what is happening to their allegation, whilst adhering to the requirements of maintaining confidentiality and observing the requirements of the Human Rights Act and the Data Protection Act. The sharing of information must not compromise any enquiries that are on-going.
- What strands there may be to the adult safeguarding enquiry and what the strategy will be for any internal investigation so that it contributes in the best way to the adult safeguarding enquiry.
- Whether contact is required with adult social care services in other areas, police, commissioners of the service, regulators of the service.
- Whether the adult at risk of abuse or neglect is safe.
- Whether there needs to be a referral to any appropriate professional regulatory body should the member of staff be a registered professional.
- How to inform the staff member concerned about the concerns.
- What needs to be done if the allegation is about a person not directly employed.
- How progress of the enquiry will be managed and kept under review.
Counterterrorism and the Prevent duties in Adult Social Care
The "Prevent" strategy
The Prevent strategy is part of the governments overall counter-terrorism strategy, CONTEST. The aim of the Prevent strategy is to prevent people from being drawn into terrorism. The Prevent strategy has three objectives:
- respond to the ideological challenge of terrorism and the threat we face from those who promote it;
- prevent people from being drawn into terrorism and ensure that they are given appropriate advice and support; and
- work with sectors and institutions where there are risks of radicalisation that we need to address.
Local Authority "Prevent" duties
Section 26 of the Counter-Terrorism and Security Act 2015 places a duty on certain bodies, including Local Authorities, to have "due regard to the need to prevent people from being drawn into terrorism" in the exercise of their functions. The Prevent Duty statutory guidance sets out the detail of how this should be done.
The Prevent duty guidance says local authorities must:
- Establish or make use of an existing local multi-agency group to agree risk and co-ordinate Prevent activity. In Surrey we have a multi-agency Prevent Executive Group.
- Use the counter-terrorism local profile (CTLP) produced by the police, to assess the risk of individuals being drawn into terrorism.
- Any local authority that assesses, through the multi-agency group, that there is a risk should develop a Prevent action plan.
- Ensure that publicly-owned venues and resources do not provide a platform for extremists and are not used to disseminate extremist views.
- Take the opportunity when new contracts for the delivery of their services are being made to ensure that the principles of the duty are written in to those contracts in a suitable form.
- Make appropriate referrals to Channel, which is a programme which provides support to individuals who are at risk of being drawn into terrorism which is put on a statutory footing by and ensure that Channel is supported by the appropriate organisation and expertise.
- Ensure appropriate frontline staff, including those of its contractors, have a good understanding of Prevent, are trained to recognise vulnerability to being drawn into terrorism and are aware of available programmes to deal with this issue.
What we will do to meet our Prevent duties:
- We will ensure Adult Social Care is an active partner at the Channel Panel. We aim for 100% attendance at the panel, both as a standing member and representation from case-holding teams for the relevant discussions when a person we are working with is known to the Channel Panel.
- We will include in our Safeguarding Strategy each year what we are doing that year to meet our Prevent duties and improve how we are doing so.
The Working Together (2018) Statutory Guidance says that where we provide services to adults who are themselves responsible for children who may be in need, these services are subject to the duties in Chapter 2 of "Working Together". As well as the general duties in that chapter, Adult Social Care has some specific duties:
- When staff are providing services to adults they should ask whether there are children in the family and consider whether the children need help or protection from harm. Children may be at greater risk of harm or be in need of additional help in families where the adults have mental health problems, misuse drugs or alcohol, are in a violent relationship, have complex needs or have learning difficulties.
- Adults with parental responsibilities for disabled children have a right to a separate parent carer's needs assessment under section 17ZD of the Children Act 1989. Adults who do not have parental responsibility, but are caring for a disabled child, are entitled to an assessment on their ability to provide, or to continue to provide, care for that disabled child under the Carers (Recognition and Services) Act 1995. That assessment must also consider whether the carer works or wishes to work, or whether they wish to engage in any education, training or recreation activities.
- Adult social care services should liaise with children's social care services to ensure that there is a joined-up approach when carrying out such assessments.
The general "Working Together" duties
- A clear line of accountability for the commissioning and/or provision of services designed to safeguard and promote the welfare of children. The services we commission and provide are those to meet the care and support needs of adults, where such needs have an impact on their parenting capacity. We have clear lines of accountability for our assessment, care and support planning and commissioning arrangements in regard to those needs.
- A senior board level lead with the required knowledge, skills and expertise or sufficiently qualified and experienced to take leadership responsibility for the organisation's/agency's safeguarding arrangements. The Assistant Director for Adult Social Care and the Head of Adult Safeguarding are both members of Surrey Safeguarding Children Partnership and provide this leadership.
- A culture of listening to children and taking account of their wishes and feelings, both in individual decisions and the development of services. Where we are involved in assessing the needs of parents, or other adults with caring responsibilities for children and young people, we aim to take account of the needs of the whole family in those assessments by ensuring we listen to contributions from all.
- Clear whistleblowing procedures, which reflect the principles in Sir Robert Francis' Freedom to Speak Up Review and are suitably referenced in staff training and codes of conduct, and a culture that enables issues about safeguarding and promoting the welfare of children to be addressed. Our corporate whistleblowing procedures meet this requirement.
- Clear escalation policies for staff to follow when their child safeguarding concerns are not being addressed within their organisation or by other agencies. Our expectation is that the starting point is that such issues can be addressed in line-management relationships. Where matter require escalation this can be done in the usual way and, where necessary, by raising the matter with members of ALT that sit on Surrey Safeguarding Children Partnership.
- Arrangements which set out clearly the processes for sharing information, with other practitioners and with safeguarding partners. We work to Surrey Safeguarding Children Partnership procedures on these matters.
- A designated practitioner (or, for health commissioning and health provider organisations/agencies, designated and named practitioners) for child safeguarding. Their role is to support other practitioners in their organisations and agencies to recognise the needs of children, including protection from possible abuse or neglect. Designated practitioner roles should always be explicitly defined in job descriptions. Practitioners should be given sufficient time, funding, supervision and support to fulfil their child welfare and safeguarding responsibilities effectively. This role is held by our Head of Adult Safeguarding.
- Safe recruitment practices and ongoing safe working practices for individuals whom the organisation or agency permit to work regularly with children, including policies on when to obtain a criminal record check. This is covered by Surrey County Council's corporate recruitment processes.
- Appropriate supervision and support for staff, including undertaking safeguarding training creating a culture of safety, equality and protection within the services they provide. We have in place arrangements for supervision and support of our staff, and our minimum training expectations include safeguarding children issues.
- Employers are responsible for ensuring that their staff are competent to carry out their responsibilities for safeguarding and promoting the welfare of children and creating an environment where staff feel able to raise concerns and feel supported in their safeguarding role. We have regular "Performance Conversations" with our staff and regular supervision, quality assurance and robust sign-off arrangements to ensure work meets the standards needed.
- Staff should be given a mandatory induction, which includes familiarisation with child protection responsibilities and the procedures to be followed if anyone has any concerns about a child's safety or welfare. This is included in our mandatory induction.
- All practitioners should have regular reviews of their own practice to ensure they have knowledge, skills and expertise that improve over time. This is covered above.
Monitoring these matters
To ensure our work with children and young people remains effective:
- Our Safeguarding Strategy each year will set out what we are doing to improve our work with children and young people
- We will work with Surrey Safeguarding Children Partnership to undertake regular s11 Children Act 2004 audits in line with the Board's expectations on frequency.
Involving a person in an enquiry
The person should always be involved from the beginning of the enquiry, unless there are exceptional circumstances that would increase the risk of abuse.
Before there as an adult safeguarding concern
In all our work with adults with care and support needs we will ensure that we will give them information about:
- What we will do if they tell us they are experiencing or at risk of abuse or neglect
- What we will do if they tell us about someone else who may be experiencing or at risk of abuse or neglect
- What we will do if they tell us about an adult safeguarding concern that may also be a crime.
Putting Making Safeguarding Personal in to practice
Conversations should happen with the person at the earliest opportunity, enabling and supporting them to identify realistic outcomes so that their views, wishes, feelings and beliefs are central in decisions about how to proceed. Making Safeguarding Personal is about talking through with people the options they have and what they want to do about their situation.
Asking questions such as "What do you want to happen?" "What is important to you?" "Is there anything that you do not want to happen?" is a helpful starting point, and is likely to result in more in-depth work at an early stage.
People cannot make decisions about their lives unless they know what the options are and what the implications of those options might be. Therefore a Making Safeguarding Personal approach needs to be applied throughout every stage of an enquiry.
Helping people to identify the outcomes they want
Whilst most people do want to be safer, other outcomes may be as, or more important, such as maintaining relationships. A person's right to safety has to be balanced with other rights: such as the right to liberty and autonomy, and rights to family life. Any intervention in family or personal relationships needs to be carefully considered, since the dynamics of these relationships can be complex. For example, an adult may choose to be in a relationship that causes them harm and emotional distress, which outweighs for them the unhappiness of not maintaining the relationship.
A person experiencing abuse or neglect may have difficult decisions to make and as such may need time to consider the risks involved and outcomes they want. Making risks and options clear and understandable is crucial to empowering and safeguarding adults and in recognising people as 'experts in their own lives'.
Some people may be unclear as to what they would like to happen, and time and skilled intervention may be required to help people express their views and wishes. Other people may want outcomes which are not possible. Open and honest discussions about reasons why certain actions may not be realistic can help the person to re-evaluate their views and consider other options.
Safeguarding interventions should be creative and flexible to take account of these differences. What a person identifies at the outset may change as the enquiry progresses, perhaps because they become more aware of their options and feel more empowered to take control of their situation.
Wherever possible it is better to capture the person's outcomes in their own words, for example "I want to feel safe in my own home again". Personalised outcomes are not conclusions to processes or service responses such as "The person is receiving increased monitoring or care".
The key focus is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them (and their representatives or advocates if they lack capacity) how best these outcomes may be realised.
Examples of outcomes people might want
Typical types of outcomes from an adult safeguarding enquiry include:
- To feel safer
- To have exercised control
- To recover
- To get new friends
- To know where to get help
- To receive an apology
- To have access to criminal justice
- To know that it won't happen to anyone else
If the adult is having difficulty identifying the outcomes that they want from their adult safeguarding work, sharing this list with them might help them to put in to words the outcomes they might want.
An adult's rights and freedom
Safeguarding enquiries needs to recognise that the right to safety has to be balanced with other rights such as rights to liberty and autonomy, and rights to family life.
The Surrey County Council must ensure that any restriction on the adult's freedom or rights under the European Convention on Human Rights is lawfully done, kept to the minimum necessary and is proportionate to the risk of harm. Any restrictions should be carefully considered and frequently reviewed.
Any intervention in family or personal relationships needs to be carefully considered, since the dynamics of these relationships can be complex to assess and intervene in. For example an adult may choose to be in a relationship that causes them emotional distress which outweighs, for them, the unhappiness of not maintaining the relationship. While abusive relationships never contribute to the well-being of the adult, interventions which reduce or remove contact with family members may be experienced as negative interventions and risk breaching the adult's right to family life under Article 8 of the European Convention on Human Rights, where this is not justified or proportionate.
Duty to arrange independent advocacy
Local authorities must involve people in decisions made about them and their care and support. No matter how complex a person's needs, local authorities are requires to help people express their wishes and feelings, support them in weighing up their options and assist them in making their own decisions.
Section 68 of the Care Act 2014 requires that a local authority must arrange, where appropriate, for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review. This should take place where any adult has 'substantial difficulty' in being involved and where there is no other appropriate individual to help them. This should be kept under review throughout the enquiry.
The Care Act sets out four areas where people may experience substantial difficulty. These are:
- Understanding relevant information
- Retaining information
- Using or weighing up information
- Communicating views, wishes and feelings.
A family member or friend can advocate on behalf if appropriate, but the 'appropriate individual' cannot:
- Already be providing care or treatment to the person in a professional capacity or on a paid basis
- Be someone the person does not want to support them, if they are able to make that decision for themselves
- Be someone who is unlikely to be able to, or available to, adequately support the person's involvement.
The role of an 'appropriate individual' under the Care Act is different to that of an individual with whom it is 'appropriate to consult' under the Mental Capacity Act. Under the Care Act, the appropriate individual's role is to facilitate the person's involvement, not merely to consult with them and make decisions on their behalf.
Where there are competing wishes and rights
The views, wishes and desired outcomes expressed by the adult are important in determining the appropriate and proportionate response to the concerns raised, and what enquiries may be needed. The person's wishes and desired outcomes, however, are not the only consideration as sometimes actions are required without a person's consent, particularly where there are overriding public interest issues, or risk to others. In these circumstances, the practitioner will need to ensure that a sensitive conversation takes place with the adult to explain how and why their wishes have to be over-ruled, listening to their feelings and the impact this action will have on them, and seeking to provide them, wherever possible, with reassurance.
Managing risks to the person
There will be occasions where speaking to the adult could put them at further or increased risk of harm. This could be, for example, due to retaliation, or a risk of fleeing or removal of the adult from the local area, or an increase in threatening or controlling behaviour if the person causing the risk of harm were to know that the adult had told someone about the abuse or neglect, or that someone else was aware of it.
The safety of the adult and the potential for increasing the risk should always be considered when planning to speak to the person. Any such situations where there is the potential for endangering safety or increasing risk should be assessed carefully and you should seek advice from the SAD or SAM or from a Safeguarding Advisor.
Where access to the adult is being denied for any reason (for example, as a result of a third party denying access to premises, or access to premises can be gained but a third party is insisting on being present and the adult cannot be spoken to alone), you should seek urgent line management advice, and legal advice where appropriate. Consider liaison with the Police, and consider the best practice guidance on Gaining access to an adult suspected to be at risk of abuse or neglect (SCIE, 2014).
When will we carry out an adult safeguarding enquiry?
When an adult safeguarding concern arises or is referred to Adult Social Care we will consider whether the duty for there to be an adult safeguarding enquiry applies.
The duty applies when we have reasonable cause to suspect that an adult in Surrey, whether or not ordinarily resident here:
- has needs for care and support, whether or not we are meeting any of those needs
- is experiencing, or is at risk of, abuse or neglect, and
- as a result of those needs is unable to protect himself or herself against the abuse or neglect or the risk of it.
In those circumstances the local authority must make, or cause to be made, whatever enquiries it thinks necessary to enable it to decide whether any action should be taken in the adult's case and, if so, what and by whom.
As this is a duty, we do not have discretion to decide not to have an enquiry if the three tests have been met. What we do have discretion over is deciding what that enquiry will involve.
Carrying out an adult safeguarding enquiry when the adult does not want one
The Care Act does not require consent for adult safeguarding work, so absence of consent is not a barrier to such work. However, the person should be informed before referring an adult safeguarding concern to the local authority, unless to do so creates disproportionate risk.
There is a link between sections 42, 9 and 11 of the Care Act 2014 which has an implication on this matter.
- Section 42 relates to when there is a duty on the local authority to ensure there is an adult safeguarding enquiry. One of the tests is that the person must have care and support needs. There is no requirement for the person to consent for the enquiry duty to be met.
- Section 9 relates to the duty on the local authority to assess the care and support needs of a person. The test is that there is a reasonable belief that the person has care and support needs, therefore people falling under section 42 of the Care Act will also fall under section 9 of that Act.
- Section 11 says that adults can decline to have their care and support needs assessed except when they lack the mental capacity to make that decision and the local authority believes the assessment is in their best interests; or
Where there is a concern that the person is experiencing or is at risk of abuse or neglect, this means that where there is a requirement for there to be an adult safeguarding enquiry, there is likely to be a requirement for the local authority to assess the person's care and support needs, and the person cannot decline this assessment.
Section 11 of the Care Act 2014 does not require the person to be unable to protect themselves. Section 9 and 11 of the Care Act 2014 can apply to a person with care and support needs who is experiencing or at risk of neglect but who does not fall within s42 Care Act because they are able to protect themselves. In such a case, the duty to assess the person's care and support needs applies, but the duty for there to be an adult safeguarding enquiry does not.
Making Safeguarding Personal where the adult does not want an enquiry or an assessment. The principles of Making Safeguarding Personal must be applied to an adult safeguarding enquiry where the adult does not want it to take place. In such circumstances it can be particularly important to understand what the person wants of the local authority and partner organisations, and their wishes may limit the scope for what the local authority can do.
In such circumstances the Care and Support statutory guidance says "local authorities must undertake an assessment so far as possible and document this".
Risk Assessment in adult safeguarding enquiries
Risk assessments and safeguarding planning are an integral part of adult safeguarding, and should begin at the outset of the enquiry and be reviewed and updated accordingly throughout. Its purpose is to address any immediate and emerging risks as the enquiry progresses, and to focus on the adult's desired outcomes and how these can be achieved. Whilst the adult's views and wishes are the leading and central consideration in safeguarding planning, risk to others must also be considered.
Safeguarding planning should empower the adult as far as possible to make choices, and to develop their own capacity to respond to risks. Wherever possible, the adult should be supported to recognise risks and to manage them.
Risk assessments and safeguarding planning should consider the following points:
- The outcomes desired by the adult, or if the adult lacks capacity outcomes that reflect the best interests of the adult
- What steps are to be taken to address immediate risks and to ensure the adult's safety in the future
- Any ongoing risk management strategy, as appropriate
- The provision of any support, treatment or therapy including ongoing advocacy
- Any modifications needed in the way services are provided, for example, same gender care, change of care provider, appointment of an Office of the Public Guardian deputy
- A lead person responsible for co-ordinating the enquiry
- The contribution of involved agencies, family, friends, and informal support networks.
- The timescales within which actions are to be achieved
- Who is responsible for the identified actions
- Contingency actions if the situation changes or risks escalate.
Risk assessments and safeguarding planning should always consider a range of options. Action may be primarily supportive or therapeutic, or it may involve the application of civil orders, sanctions, regulatory activity, criminal prosecution, disciplinary action or de-registration from a professional body.
Where an adult lacks capacity to make decisions about managing risks themselves, then the range of options identified should be discussed with the adult's representative or advocate to work to help the adult to stay in control of their life, as far as possible.
Using risk assessment tools
Adult Social Care will produce good practice guidance on adult safeguarding enquiries which will include tools for assessing risk. Given the range of issues that adult safeguarding enquiries cover, a decision will need to be made case-by-case as to what are the best risk assessment tools to use for the case in hand, but there should be a presumption that where there is a relevant standardised or well-tested risk assessment tool available it should be used.
Dealing with residual risk
Where an adult with capacity to make an informed decision about their own safety does not want the Safeguarding Plan to address all or some of the risks they face, this does not override a professional's responsibility to share key information with relevant professionals.
If there appears to be significant risk to the adult, and no one else, consideration would need to be given to whether their wishes should be overridden. The adult's wishes should not stop professionals from fulfilling their responsibilities in relation to appropriate sharing of information.
In these situations there should always be a presumption that adult will be:
- Advised about what information will be shared, with whom and the reasons for this.
- Advised that their views and wishes will be respected as far as possible by the local authority or other agencies in relation to any response they may have a duty to make.
Professionals should be alert to the risk of situational incapacity, where a person who would otherwise have capacity no longer has it due to their circumstances. This might be, for example, as a result of coercive or controlling behaviours by another person. This can be a complex issue to respond to and consideration should be given to escalating the matter and / or seeking specialist advice, including from legal services.
Abuse by a person with care and support needs
A person with care and support needs may be person creating the risk of abuse or neglect that another is facing. In some instances the abuse or neglect may be unintentional. This makes the need to take action within the adult safeguarding framework of the Care Act no less important, but it will inform the decision about how an enquiry will be taken forward and what actions will be needed at the end of the enquiry. However, the primary focus must still be how to safeguard the adult.
It may be necessary to address what may have become acceptable behaviour. Such norms can develop in the context of a family, a community or within a particular service setting. This can take the form of an acceptance that adults with care and support needs abuse each other. They can arise where behaviour or attitudes that are abusive become to be accepted and condoned by staff or adults with care and support needs. Staff should therefore familiarise themselves with what constitutes abuse and act upon this regardless of the level of the vulnerability of the person who may be posing the risk.
When adults with care and support needs are detained under the Mental Health Act 1983 they are still entitled to be both protected from abuse and prevented from abusing other vulnerable adults.
People with care and support needs who abuse their carer
There are some instances where people with care and support needs abuse, or pose a risk to, relatives, neighbours or friends who look after them. Carers at risk of abuse from the person with care and support needs often may be unable to take advantage of the remedies available because of the nature of the relationship with the person they care for and the dependence of that person on them.
Carers fall outside the remit of s42 of the Care Act, unless they have care and support needs in their own right. However, carers need to have any potential or actual risk to their health and well-being recognised and acknowledged by professionals working with the vulnerable adult. A carer's assessment should be completed and the carer should be offered help and support in their own right. It must not be assumed that the carer is willing to continue looking after the person with care and support needs and the carer must be given the opportunity to explore their feelings about the situation and to consider their options. Consideration should be given to any measures that could reduce the risk, such as a medication review for the person with care and support needs, help with behaviour management, and so on.
Surrey Safeguarding Adults Enquiry Method (SSAEM)
The Method is intended to support good practice in adult safeguarding enquiries while enabling case-by-case flexibility about how a concern is responded to. Using the Method helps to:
- Ensure enquiries are well planned in ways which help avoid confirmation bias and groupthink leading to prematurely closing lines of enquiry
- Risks are identified and managed, using standardised risk assessment tools where possible, to help avoid optimism bias
The SSSAEM has four phases:
- Manage immediate risk
- Apply the s42 threshold to decide if there will be an enquiry.
- Establish what we want to achieve
- Decide what the enquiry will involve.
- Carry out the enquiry
- Analyse what has been learned and make judgements; What happened? Why did it happen? What do we need to do as a consequence?
- Ensure that what needs to be done will happen
- Consider whether a Safeguarding Adults Review is needed.
Surrey Safeguarding Adults Board set out the SSAEM in its Adult Safeguarding Policy and Procedure.
- What do I need to do to manage any risks that cannot wait?
- Have I got the information I need to decide if the s42 Care Act threshold has been met?
- If not, what do I need and how will I get it? Can I get this by end of next working day?
- Has the duty to have an adult safeguarding enquiry been met?
- If there won't be an enquiry, what else might need to happen?
Did the referrer, or someone who passed the information to them, have a concern that someone might possibly be an adult with care and support needs who is at risk of abuse or neglect?
- If the answer is "Yes", then this is an adult safeguarding concern. Go on to question 2 which considers the local authority's response to that concern;
- If the answer is "No", then this is not an adult safeguarding concern.
Does the local authority have reasonable cause to suspect that an adult with care and support needs in our area is unable to protect themselves from some specific risk of abuse or neglect?
- If the answer is "Yes" then there must be an adult safeguarding enquiry;
- If the answer is "No", then there cannot be an adult safeguarding enquiry.
If the answer to either question 1 or question 2 is "No", consider if other actions may be needed:
- If a carer is at risk of abuse or neglect, a Carer's Assessment may be needed;
- If a person with care and support needs is a risk to others, there may be a need for an assessment of their care and support needs or a review of a care and support plan;
- If a person with care and support needs is at risk of abuse or neglect there may need to be a s9 Care Act assessment which s11(2)(b) Care Act bars them from refusing. This is true even if they are able to protect themselves from the abuse or neglect.
- What are we worried about?
- What are the different explanations for what might have happened? What information would help us choose between them? What information have we got? Where might we get any information that we are missing?
- What contextual information do we need? Have there been concerns before about this adult, this source of risk, or this type of issue. What do we need to take account of from that work?
- What do we want the enquiry to achieve? What outcomes does the person want? What outcomes do other people want?
- What will need to happen for us not to be worried any longer? What are the strengths and the protective factors in this situation?
- What will the enquiry consist of?
- What other processes will contribute?
- How do these processes relate to one another?
- What do I need from other people? Do they know what is needed from them, how to do it, and when to do it by?
- Have I got actions for each of the objectives of an enquiry? Establish the facts, ascertain the person's views and wishes, protect from abuse or neglect, assess needs for protection, support and redress, enable resolution and recovery, decide on follow-up actions for the person or organisation responsible for the abuse.
- Have I applied RASCI to each action? Is everyone clear for each action who is
- Does the Mental Capacity Act have any relevance?
- Does the adult have the support they need? How will the person be involved in the enquiry? Is there a need for advocacy?
- Do I need to let anyone else know? Is there a possible crime that needs to be reported to the police? Is there an issue for the Coroner? Does anything need to be escalated? Who to, why, who by, and what do I need from the person this is escalated to? Have I let the person who made the referral know what is happening?
- Have I done what I need to do to manage:
Confirmation bias - Have I considered all the alternatives? Have I asked someone to act as "Devil's Advocate"?
Optimism bias - Have I identified and understood all the risks? Have I done a robust risk assessment? Are there particular risk assessment tools I should be using?
Groupthink - Have we all gone along with the same ideas and missed other ideas we should be thinking of? Have we involved other people whose expertise would be useful? Have we listened properly to what they say, particularly if we don't agree with them?
Put the plan in to action
Carry out the actions identified on the Enquiry Plan. As the enquiry progresses, keep under review the Enquiry Plan and the outcomes the adult wants to achieve. Are they on track for completion? Do they need to be adjusted?
Deal with emerging risks
- Is there an appropriate risk assessment tool to use for this situation?
- What do I need to do to manage optimism bias in this instance?
- Identify the hazards
- What is the likelihood and impact of each hazard?
- What can be done to remove or mitigate the risks?
- What does the person want? What risks do they want to live with?
- Carry out a "pre-mortem": Imagine that we did what we are considering doing, and in 12 months' time we are looking back at this and regretting taking this option, what went wrong?
Analyse what has been learned and make judgements
It will often be useful to produce an adult safeguarding enquiry report which sets out:
- What were we worried about
- What did we do to look in to the concern
- What facts have been established
- What happened?
- Why did it happen? What were the root causes?
- Is there anything that remains uncertain?
- Are there any points of disagreement?
- What outcomes did the adult want and have they been achieved?
- What risks have been identified and how are they to be managed?
- What do we need to do as a consequence of what we have learned? What actions are needed to: Protect the adult and anyone else from abuse or neglect, provide the adult with any support they need, enable resolution and recover, and secure redress for the adult, take follow-up actions for the person or organisation responsible for the abuse.
- Have we identified corrections, corrective actions and preventative actions.
Share the draft report with anyone who should have it, and take account of their feedback in redrafting. If there are issues that cannot be resolved, say so in the report.
- Ensure that what needs to be done will happen
- Consider whether a Safeguarding Adults Review is needed.
Were the adult's desired outcomes achieved?
At the conclusion of each enquiry, the local authority should obtain direct feedback from the adult regarding their experience of the enquiry, in order to evaluate the impact of the safeguarding intervention, and to ascertain the difference this has made to the person's life, in line with a Making Safeguarding Personal approach.
On completing an adult safeguarding enquiry the local authority must decide what actions, if any, should be taken and who by. The statutory guidance calls these actions the Safeguarding Plan or Protection Plan, using both terms interchangeably. In Surrey, we call this the Safeguarding Plan.
Does the Safeguarding Plan need to have a review process?
Whether a Safeguarding Plan needs to have a review process will be decided case-by-case by the SAD for that adult safeguarding work. It might be that:
- There is no need for a Safeguarding Plan, most probably because the enquiry has established that the person was not at risk of abuse or neglect or is not in need of protection or support;
- There is a Safeguarding Plan but there is no need for a review process, most probably because all its elements have already been achieved;
- There is a Safeguarding Plan, but all its elements can be monitored or reviewed by other processes, typically because they each constitute business-as-usual for someone; or
- There is a Safeguarding Plan, and there will be a stand-alone review process for that plan as part of the adult safeguarding work on the case. Reasons for taking this approach might be because there is no other way of having assurance that the actions will take place, there are complex interdependencies between the actions that need to be coordinated, or that the person is living with a significant amount of residual risk despite the actions that have been planned.
At the end of an enquiry the local authority is responsible for ensuring feedback regarding the outcomes of the enquiry is passed to all those who should receive it including the adult, the person or service thought to be the cause of risk, and any other relevant agencies or organisations involved. This might include whoever referred the concern to the local authority.
Safeguarding Adults Review
On completion of an Adult Safeguarding Enquiry the SAD should consider whether the matter should be referred to Surrey Safeguarding Adults Board for consideration for a Safeguarding Adults Review under the Board's policy and procedures.
Adult Safeguarding roles in the SSAME
The below show how the SAM, SAD, LEO and SAECs might typically contribute to a piece of adult safeguarding work.
Adult Safeguarding Roles and the SSAME
Safeguarding Adults Decision Maker (SAD)
- Decides whether there will be an adult safeguarding enquiry. If no enquiry, decided what other actions may be needed and / or feedback given.
- Decides what the enquiry will involved.
- Appoints the SAM.
- Decides whether the enquiry is completed. If it is, decides if a Safeguarding Plan is required.
- Decides if a referral to SSAB for consideration for a Safeguarding Adults Review is needed.
Safeguarding Adults Manager (SAM)
- Appoints LEO and allocates resources.
- Day-to-day management of the enquiry.
- Implements Safeguarding Plan.
Lead Enquiry Officer (LEO)
- Leads the carrying out of the enquiry.
- Produces an enquiry report.
- Implements Safeguarding Plan.
Safeguarding Adults Enquiry Contributor (SAEC)
- Provides information, advice, and support.
- Implements Safeguarding Plan.
Adult Safeguarding Roles in the "Decide" phase
Safeguarding Adults Decision Maker (SAD)
On receipt of an adult safeguarding concern, the SAD considers whether the information already available allows for a decision whether the criteria in s42(1) Care Act are met:
- If they are met, then there must be an adult safeguarding enquiry. Move on to the "Plan" stage;
- If they are not met, there cannot be an adult safeguarding enquiry. Consider what other actions, if any, may be required;
- If it is not possible to determine if the criteria are met, decide what actions are needed to gather information that will allow a determination to be made. However, if this will take longer than the end of the working day following the concern being received, the presumption should be made that an adult safeguarding enquiry is needed.
Safeguarding Adults Manager (SAM)
- Information gathering, to inform the SAD
Lead Enquiry Officer (LEO)
- Information gathering, to inform the SAM
Safeguarding Adults Enquiry Contributor (SAEC)
- Information provision, to inform the LEO
Adult Safeguarding Roles in the "Plan" phase
Safeguarding Adults Decision Maker (SAD)
- Appoints the SAM
- Consults with the adult with care and support needs, SAM, LEO, SAEC and others on what the enquiry will involve
- Decides on what the Enquiry Plan will be.
Safeguarding Adults Manager (SAM)
- Appoints the LEO and allocates resources
- Advises the SAD on what the Enquiry Plan should be.
Lead Enquiry Officer (LEO)
- Advises the SAM on what the Enquiry Plan should be
- Coordinates agreement on how the Enquiry Plan should be put into action.
Safeguarding Adults Enquiry Contributor (SAEC)
- Advises the LEO on what the Enquiry Plan should be
- Provides advice and support to the LEO on how the Enquiry Plan should be put into action.
Adult Safeguarding Roles in the "Do" phase
Safeguarding Adults Decision Maker (SAD)
- Oversees progress of the Enquiry
- Decides if the Enquiry has been completed to the required quality
- Revises the Enquiry Plan in response to emerging issues.
Safeguarding Adults Manager (SAM)
- Day-to-day management of the enquiry
- Escalates strategic issues to the SAD.
Lead Enquiry Officer (LEO)
- Leads the carrying out of the enquiry
- Drafts the enquiry report.
Safeguarding Adults Enquiry Contributor (SAEC)
- Provides advice and support to the LEO.
Adult Safeguarding Roles in the "Review" phase
Safeguarding Adults Decision Maker (SAD)
- Consults, and decides on, the content of the Safeguarding Plan and any review process that goes with it
- Decides if a Safeguarding Plan is required and, if so, what it includes
- Decides whether there needs to be a review process for the Safeguarding Plan, or whether it will be dealt with as "business as usual" for the owners of the actions
- Decides whether to refer to the Safeguarding Adults Board for consideration for a Safeguarding Adults Review
- Decides when the adult safeguarding work has finished.
Safeguarding Adults Manager (SAM)
- Provides advice and information to the SAD
- Implements the Safeguarding Plan.
Lead Enquiry Officer (LEO)
- Provides advice and information to the SAM
- Implements the Safeguarding Plan.
Safeguarding Adults Enquiry Contributor (SAEC)
- Provides advice and information to the LEO
- Implements the Safeguarding Plan.
Who carries out the enquiry?
Identifying who does what happens during the Plan phase of the SSAME. Where existing processes are being used to form all or part of the enquiry it may be clear who the owner of those processes is and therefore who will take those actions.
While Surrey County Council can cause some or all of an enquiry to be undertaken by others it cannot delegate this function entirely. The overall decision making, and the need to ensure the enquiries and actions have been undertaken, remains with the council. The local authority will be responsible for ensuring that when it causes an enquiry, or part of an enquiry, it is referred to the right place and is acted upon. This will include:
- Clearly communicating the request to complete an enquiry, or part of an enquiry, to an accountable person in the organisation, This might include an explanation of why they are best placed to do this
- Being satisfied that the organisation undertaking the enquiry is competent to do so and that there is no conflict of interest that the organisation, or any particular individual, undertakes the actions required
- Confirming the legal context of the request, including the statutory nature of the duty to co-operate under S6 or section 7 of the Care Act if relevant, and the duty of candour under S81 of the Care Act 2014
- Agreeing the timescale within which the work should be completed
- Agreeing the actions that should be undertaken
- Agreeing any requirements about how the actions will be carried out, such as particular questions that are to be explored with people or particular documents that should be provided
- Agreeing who will undertake the actions. This might also involve deciding who will not undertake the actions, such as to ensure appropriate independence or avoid actual or perceived conflicts of interest
- Confirming how the enquiry outcomes will be fed back to the council, and who to. Typically, this will be to the person acting as LEO.
- Recording the actions agreed.
Responsibilities of Surrey County Council
If Surrey County Council asks another organisation to contribute to some or all of the actions on an Enquiry Plan then it must monitor that those actions are completed on schedule and address this with that organisation if they are not.
When the actions are completed Surrey County Council must satisfy itself the process used and the outcome of that work is satisfactory. If it is not it must either:
- Request that organisation to remedy the situation; or
- Take on the actions itself.
Fairness, independence and natural justice
Where an adult safeguarding concern relates to risks of abuse or neglect within a service provision, getting the balance right of the responsibility of that service to respond to the concerns against the need to have due rigour and independence of the enquiry.
The Care and Support statutory guidance sets out some expectations for when this arises in regard to regulated health and social care settings, which can applied in other settings. It says:
"The employer should investigate any concern (and provide any additional support that the adult may need) unless there is compelling reason why it is inappropriate or unsafe to do this.
For example, this could be:
- a serious conflict of interest on the part of the employer,
- concerns having been raised about non-effective past enquiries or
- serious, multiple concerns, or
- a matter that requires investigation by the police."
(Care and Support statutory guidance, paragraph 14.70)
The local authority has to take in to account natural justice principles when deciding who will carry out the enquiries that contribute to a s42 Care Act enquiry. Particular weight should be given on this matter to the views of the adult or their representative, and the person or organisation that may be the source of risk. In doing so, they might consider:
- In applying the "No-one should be judge in their own cause" principle, whether the arrangements would result in actual bias, or the appearance of possible bias
- In applying the "Hear the other party too" principle, whether those with an interest in the matter will consider that the arrangements proposed amount to a fair process.
The local authority, when deciding how the enquiry should be carried out, should be mindful of not using too high a threshold when determining what might amount to a "compelling reason". Some local authorities have come in for criticism for doing so. For example.
A Safeguarding Adults Review was critical of a local authority that asked a care home to carry out enquiries when a person living there was seriously injured. The local authority did not ensure that the police investigated, and asked the Area Manager for the care home provider to enquire in to the matter. The Area Manager delegated this to the manager of the care home where the injury happened, and the local authority did not challenge this.
- A patient in a NHS hospital died in circumstances where there may have been abuse or neglect. The local authority asked the Hospital Trust to use its Serious Incident process as the way of carrying out the adult safeguarding enquiry. A Coroner's Court was critical of a local authority for not ensuring that the Serious Incident investigation was carried out by someone independent of the Trust
If there are concerns over these issues, ways of addressing them might include
- Resolution through negotiation between the parties involved. If this is problematic it may need escalation within or between any organisations involved;
- Where the matter involves organisations that are "Relevant Partners" as per s6 of the Care Act 2014, the local authority may make the request to the other organisation under s7 of the Care Act which places the other party under some obligations about their response to the request;
- The matter may need to be drawn to the attention of Surrey Safeguarding Adults Board.
Deciding on roles for adult safeguarding work that cuts across more than one ASC team
This section relates to adult safeguarding enquiries that cut across more than one team within Adult Social Care in Surrey. Where the issue involves more than one local authority please refer to the ADASS out-of-area safeguarding adults guidance (PDF).
- "Locality Team" here means a Locality Adult Social Care Teams and any hospital-based teams within that locality's area.
- "Specialist service" means any other case-holding team such as the Transition team, Learning Disability and Autism service, or Locality Mental Health Adult Social Care Teams.
Safeguarding concerns will sometimes occur cut across the responsibilities of more than one team in Surrey, for example:
- An incident occurs in the area covered by one Locality team to a person that another Locality team have case-holding responsibility for;
- An incident occurs in the area covered by a Locality team to a person that a specialist countywide team such as the Transition team or Learning Disability and Autism service;
- An incident occurs within a hospital relating to a person who has since been discharged home, where the service delivery by the hospital is the source of risk.
In the past, the practice has been that the team that cover the geographical area where the risk of abuse has arisen has led the adult safeguarding work. This has sometimes been problematic as it has led to decisions that are not person centred or are inconsistent with the Making Safeguarding Personal approach of the Care and Support statutory guidance. Adult safeguarding work covers a wide variety of situations so it is not possible to be prescriptive about who will do what. This guidance sets out some principles to support decision making about this. Making these decisions should be done in partnership between the teams involved.
Principles for decision making
Where there is to be an adult safeguarding enquiry, and the matter cuts across more than one Adult Social Care team in Surry, the teams involved should provide mutual support, and work together to provide the best response for the person. It is useful for Locality Teams and Specialist Teams to be aware of patterns of abuse or neglect within the communities in their area, or with service providers in their area or who work with their client group.
In deciding who will do what in the enquiry, including who will hold the SAD, SAM and LEO roles, the factors and considerations in Table 1 below should inform the decision making.
Where there is a dispute over the respective roles of teams it is expected that the Team Managers of those teams resolve the matter in the first instance. Where they are unable to it will be escalated to the respective Senior Managers for resolution.
The next table demonstrated factors to consider when dealing with adult safeguarding enquiries that involve more than one ASC team. If column A is present, it may indicate the need to consider, or to lend weight to column B:
|Column A||Column B|
|The person has an allocated worker in an ASC team.||The allocated worker being the LEO.|
|No current allocated worker, but there is a worker in the case holding team who is known to the person.||That person being the LEO or, if that is not possible, the work staying within the case holding team but going to another person within that team, to offer some continuity.|
|Is the person already known to the Transition team or to the LD and Autism service?||Consider whether that team should lead the work.|
|Does the person have a learning disability, but is not known to the Transition team or to the LD and Autism service?||Consider whether that team should lead the work.|
|Is the source of the risk a regulated provider specialising in working with people with a learning disability, mental health need or some other factor that matches the remit of a specialist service?||Consider whether the SAD, SAM or LEO roles should come from the relevant specialist service, to allow the team to have an overview of specialist service provision and / or in order to bring relevant expertise to the adult safeguarding enquiry.|
|Is the source of the risk a regulated provider that works with a wider cohort of people than that of the specialist service working with the individual involved? This will include acute and community hospitals in the area.||Consider whether the SAD could be from the Locality team in whose area the service sits, with the SAM and / or LEO from the case holding team. Division of labour between a hospital-based team and other teams should take in to account issues such as where the person is now, where the risks arose, and links with service providers.|
|Are there community safety, public safety or public interest considerations, such as hate crime, mate crime, county lines, or cuckooing?||Consider whether the SAD could be from the geographical team to utilise local relationships and networks with police and housing and so on, and the SAM and / or LEO may be from the case holding team.|
|Does the cause for concern relate to the work carried out by or decisions made by the case holding team?||Consider whether the LEO, SAD or SAM roles should sit with someone outside of the case holding team, in the interests of natural justice, public assurance, and / or avoiding actual or perceived conflict of interest.|
If there is no reason for the Locality team covering the area the incident occurred in to be involved due to community safety, public safety or public interest concerns, or in relation to a local service provider, then the starting assumption shall be that staff in the case holding team will act as the SAD, SAM and LEO.
Analysing the evidence and making sound judgements
At the end of the Enquiry the LEO will bring together all the relevant information, analyse it, and make recommendations to the SAD based on their judgements from that analysis.
Where the situation is a straightforward one, it may be possible to record these steps briefly in the context of the general record of the adult safeguarding work. But in most instances, it will be preferable for the LEO to produce an Adult Safeguarding Enquiry Report. It will be for the SAD to determine the approach to be taken on any particular case.
A report from the LEO also helps with making clear what information has been found and how any judgements based on that have been arrived at. This can not only assist the LEO with their own critical thinking on the matter it also makes that transparent to others so that, in the spirit of open-minded adult safeguarding work, others can scrutinise and challenge the work, which can help improve it.
For this to happen, the expectation must be that drafts of the report will be shared for comments, and that there will be an iterative process of redrafting and making comments until either all areas of contention have been resolved or, where they cannot be after all reasonable steps have been taken, the report reflects these issues, the differing points of view, and how the LEO reached their view in light of them.
As adult safeguarding work deals with issues of abuse and neglect it will be inevitable that matters will arise where people have acted in bad faith or with malign intent, either in regards to the issues that led to the concern or in the relation to the undertaking of the adult safeguarding enquiry. The LEO will need to be attentive to this possibility and to name this as an issue if they believe it pertinent to the case in hand.
The Enquiry Report
Typically, the enquiry report will include information under these headings:
- What we were concerned about
- Any relevant contextual information
- What outcomes the adult wanted from the enquiry
- What outcomes anyone else wanted from the enquiry
- What the possible explanations were that were considered
- What the enquiry involved
- What information was found, including any gaps in information, where through corroboration, triangulation and so on the information is reliable, where there are anomalies, inconsistencies or unreliability in the information and areas of disagreement
- What the adults views and wishes are, including an account of how they have been involved in the safeguarding adults enquiry
- The LEO's judgement, and an account of how that judgement was reached, on what facts have been established and what needs the adult has for protection, support and redress.
The LEOs judgement and recommendations
- Whether the adult has experienced or was at risk of abuse or neglect
- If they have experienced or been at risk of abuse or neglect, what were the causes of this? This should identify both immediate and root causes
- Recommendations for the Safeguarding Plan. This will include corrections, corrective actions and preventative actions that have been taken already or ought to be taken in order to protect from the abuse and neglect, in accordance with the wishes of the adult, take follow-up action with regard to the person or organisation responsible for the abuse or neglect and enable the adult to achieve resolution and recovery
- A view whether the outcomes the adult wanted have been achieved, or are likely to be achieved by implementing the Safeguarding Plan, the outcomes others wanted have been achieved, or are likely to be achieved by implementing the Safeguarding Plan or there should be a referral to Surrey Safeguarding Adults Board to undertake a Safeguarding Adults Review.
Analysing the information and establishing the causes
The LEO's analysis of the information should include consideration of the causes of any abuse or neglect that the person has experienced or been at risk of. This should include both the immediate causes and the root causes.
Root cause analysis
Root cause analysis is a method of structured risk identification and management in the aftermath of adverse events. It is not a single technique but is a range of approaches and tools that are used to establish how and why an incident occurred in an attempt to identify how it, and similar problems, might be prevented from happening again.
We will include in our good practice guidance on safeguarding information about root cause analysis in adult safeguarding enquiries.
Developing the Safeguarding Plan
Enable the adult to achieve resolution and recovery
Activities and approaches that may be helpful to include in the Safeguarding Plan in order to enable the adult to achieve resolution and recovery might include:
- Personalised information and advice to assist the person to make informed choices about their situation and to help them to weigh up the benefits and risks of different options.
- Ensuring that they are able to access the support of an independent advocate when needed in order to ensure their rights and wishes are respected when a person needs some assistance to make decisions about their life, that
- Practical support such as door locks, entry devices, personal alarms, telephone, CCTV, use of assistive technology
- Supporting to build their self-esteem and sense of self-worth in order to empower them to make decisions about and take control of, their situation
- Support to develop their awareness, skills and confidence to recognise and manage potentially exploitative or harmful situations should these arise
- Activities aimed at increasing health and wellbeing
- Joining a peer support or circles of support network to provide positive role models and a broader view of the options available to address their problems and issues within a safe and supportive environment
- Counselling or other forms of person-centred therapy to help the person come to terms with their experience and to realise their ability to take control of their lives
- Mediation and conflict resolution as a means of the respective parties reaching their own decisions about the situation and to have the opportunity to improve their communication and chances of long-term cooperation
- Restorative justice or practice to give the person the chance to meet or communicate with the person(s) responsible for the harm caused in order to explain the impact this experience had on them. This can empower the person who was harmed by giving them a voice and by holding the person responsible to account for what they have done
- Family Group Conference or network meeting in order to engage and empower the network of extended family members and friends to participate in support for individuals
- Providing information about the civil remedies available to them such as applying for an injunction.
Two ways that can be useful to check a draft Safeguarding Plan is covering all that it should are to:
- Check it against the objectives that an adult safeguarding enquiry should meet
- Check that it includes both corrective actions and preventative actions.
Check against the objectives of an enquiry
The first three objective of an adult safeguarding enquiry may well have been mostly or fully addressed during the enquiry. The objectives are:
- Establish facts
- Ascertain the adult's views and wishes
- Assess the needs of the adult for protection, support and redress and how they might be met.
The actions in the Safeguarding Plan will be how the remaining three objectives will be met. These are:
- Protect from the abuse and neglect, in accordance with the wishes of the adult. For example changes to service provision, developing skills, changing financial arrangements, change of accommodation. It may also include protective measures for other people that may be affected by the issue.
- Make decisions as to what follow-up action should be taken about the person or organisation responsible for the abuse or neglect. For example action by an employer, contract holder, a regulator, referral to a professional body, application to a Court, criminal justice process and enable the adult to achieve resolution and recovery. This will be informed by the assessment of the needs of the adult for protection, support and redress and how they might be met.
Check for corrective actions and preventative actions
An action taken to put right a problem that has occurred such as:
- Medical treatment to an injury sustained due to neglect
- Repayment of money taken as a result of financial abuse.
Action taken to eliminate the cause of a problem and prevent reoccurrence:
- Retraining of staff in good manual handling practice
- Putting in place a policy where all cash handling records have a countersignature.
Dealing with multiple adult safeguarding concerns
It is not uncommon that during a piece of adult safeguarding work that further concerns emerge that may be related. There is a balance to be struck between:
- Keeping different issues separated to avoid conflation
- Paying attention to the links between related issues
- Sharing efforts across related pieces of adult safeguarding work in the interests of efficiency
In particular, it can be tempting to blend the recording of emerging concerns in to an existing piece of adult safeguarding work in the interests of perceived efficiency. The risks of doing this are:
- We will not have an accurate picture of the number of concerns that there are, if single records relate to multiple issues.
- If two separate concerns are merged in to a single recording process, this will create a problem in accurately recording prevalence of abuse if there are different findings from the two different concerns.
- We know from our quality assurance of adult safeguarding enquiries that when two or more concerns are merged in to a single process, there is a significant risk that one or more of the issues gets lost and the risks relating to that issue may be not well understood or managed.
- We know from experience that should there be a subsequent process such as a complaint, Coroner's Inquest or Safeguarding Adults Review, that it is exponentially more difficult to account for the decisions we made and actions we have taken when the records of two or more issues are blended. Any efficiencies that were hoped for can be lost multiple times over in the efforts needed to respond to those processes in such circumstances
For these reasons, our starting position will be that each adult safeguarding concern will need to be recorded separately and we will apply the SSAEM to each concern. However, that does not preclude us from looking for reasonable efficiencies through, for example, taking actions that meet the objectives of more than one related concern or enquiry.
When further concerns arise in relation to the same adult
More instances of a similar issue
These should be separate pieces of adult safeguarding work for each concern, but efficiencies should be sought in how to bring the practicalities of carrying out the separate enquiries together.
If there continue to be further instances of similar issues, this may be an indicator that the Safeguarding Plan is not as effective as it should be and needs to be critically evaluated.
Instances of a different issue
These should be separate pieces of adult safeguarding work for each concern, and it may be more difficult to find efficiencies in bring the separate enquiries together.
Attention should be given to whether the presence of the multiple concerns is an indicator that the situation may be riskier than has previously been apparent.
When further concerns arise in relation to the same source of risk
This may arise, for instance, when several people using the same service are at risk of neglect or organisational abuse from that service. It may be useful to pay attention to:
- Where the actions taken in one enquiry might also be able to support the actions needed to carry out other enquiries
- Where there may be common risk factors or indications of a pattern of related events
- Where there may be common actions across Safeguarding Plans
- Where multiple pieces of adult safeguarding work are picking up common issues which needs to be highlighted to the service provider, commissioner or regulator.
Consideration should be given to having the same person acting as SAD or SAM for related pieces of adult safeguarding work, to facilitate identifying efficiencies or addressing common issues. If this is not practicable, then ensuring there is good communication between the SADs or SAMs for related pieces of adult safeguarding work.
Situations such as these should inform decision making about who is best placed to undertake the strands of the enquiry. There may be a need to take this in to account when planning an enquiry or reviewing the plan of an enquiry already underway.
Managing information in adult safeguarding enquiries
Information governance issues in adult safeguarding work are not different than any other work that we do. Section 42 of the Care Act can be the statutory gateway for information sharing, but how we make decisions about information sharing in that context is the same as we do in others.
Good planning of adult safeguarding enquiries helps to avoid most of the problems that can occur in managing information in adult safeguarding enquiries.
Natural justice and sharing information
As we apply the principles of natural justice in our adult safeguarding work we know from the outset of an adult safeguarding enquiry that the starting position is that we will have to share the concern with the person or organisation that is the source of risk, unless there is a compelling reason not to do so. A compelling reason not to do so might be because we have reasonable cause to suspect that the sharing of information would increase the risk to the adult with care and support needs, or others, to a degree that it would be a matter of public or vital interests not to share the information.
When the person referring the concern wishes to remain confidential
It is essential that clear expectations are set with the person referring the adult safeguarding concern with us who will be told what and when about the referral.
Some people may choose to remain anonymous, at least to some involved in the matter. We should be clear to people asking us to do so that we will make efforts to comply with such a request, where we reasonably can, but that will not prevent others from making inferences about who may have referred the concern to us. They may guess correctly or incorrectly, which may have an impact for the person making the referral, the adult the referral is about, or others.
Setting expectations about what will be shared, who with, when and how
The enquiry planning should anticipate what information will need to be shared with who, when it will happen and how this will be done.
When asking a person or organisation to contribute to an adult safeguarding enquiry it is important to set expectations with them about what will be done with the information they provide and who will have access to it.
This can be of particular importance where there are processes involved that are dealing with particularly sensitive information, or there are more complex information sharing issues in play. This might arise, for example where there is a police investigation, regulatory action or where an employer may be using a disciplinary process. In such cases, early consideration of, and setting shared expectations about, what information will be shared, who with, when and how will be essential. Where the work involved includes people being interviewed, this will also involve ensuring there is clarity about who will be undertaking these interviews, what information might be shared and what purposes it can be used for, and also ensuring that there are clearly understood arrangement sin place regarding what the person being interviewed is told about the purposes of the interview, who the information will be shared with, what support or representation they can have and so on.
If there is a meeting as part of the adult safeguarding work it is important that everyone invited to the meeting is clear who will receive a copy of the meeting minutes, particularly if those people are not present at the meeting as this can be less clear to attendees. The record of the meeting should also include in it who will be receiving copies.
Adult Safeguarding issues that cross local authority boundaries
The duty in s42 of the Care Act falls on the local authority where the person is. This might be different from the local authority with s9 and s11 Care Act duties, which will be the local authority where the person is ordinarily resident.
The local authority with the s42 duty cannot delegate this duty to any other local authority, but there is scope for deciding case-by-case what each local authority will do as part of the Enquiry Plan and / or the Safeguarding Plan.
In such circumstance the ADASS Out-of-Area Safeguarding Adults Guidance (PDF) produced by ADASS should be used as a framework for negotiating these. In broad terms, these say that the host authority (the area where the abuse or neglect occurred) will take the lead in terms of responding to the safeguarding concern. The placing authority should be involved in and contribute to any enquiry undertaken.
Where a safeguarding enquiry is being undertaken by a Local Authority and the person moves to reside in another Local Authority, the Local Authority who is undertaking the enquiry will ensure contact is made with the new Local Authority to pass on any information as required, and agree roles and responsibilities in concluding the enquiry.
Working with another local authority on an adult safeguarding enquiry where we have the s42 Care Act duty
When working with other local authorities we may need to do more that request they review a person. We should tell them what we can about what the concern is as they won't have information if it is not about their person, so we need to make sure they have all the information about their person, and make sure they have enough information to understand the risks if the concern wasn't about their person.
We need to be clear what we expect from them. We may need to tell them:
- We want them to find out what happened
- Who we need them to speak to
- to establish why it happened
- Get any information that sheds light on individual or organisation responsibility
- Look at what has been done to put the matter right
- Take a view on hat has been done, or needs to, to prevent this happening again.
Where an enquiry touches on the practice of another local authority
Complexities can arise where the cause for concern that an adult safeguarding enquiry is looking in to relates to the actions or responsibilities of another local authority. This can be particularly true when the issues in an adult safeguarding 42 enquiry led by one local authority might relate to matters that need to be addressed through complaints or H.R. processes of another local authority. Where Surrey County Council is involved in such circumstances there should be early discussions of the respective roles and responsibilities of the two local authorities at an appropriately senior level.
Safeguarding Adults Reviews
What is a Safeguarding Adults Review?
A Safeguarding Adults Reviews (SAR) is a multi-agency process that identifies learning with the aim of prevent abuse and neglect in the future. SARs are arranged by Surrey Safeguarding Adults Board. Adult Social Care can refer cases to the Board where it appears that a SAR is required or may be useful even if not required.
A SAR is not intended to investigate allegations of abuse or neglect. Rather, the focus is on multi-agency learning through consideration of how agencies worked together, with the intention of improving how they do so in the future.
When should there be a SAR?
Safeguarding Adults Boards have a duty to arrange a SAR if there is reasonable cause for concern about how the SAB, members of it or other persons with relevant functions worked together to safeguard an adult in its area with needs for care and support (whether or not the local authority has been meeting any of those needs) and;
- if the adult has died, and the SAB knows or suspects that the death resulted from abuse or neglect (whether or not it knew about or suspected the abuse or neglect before the adult died); or
- the adult is still alive, and the SAB knows or suspects that the adult has experienced serious abuse or neglect.
A SAB may arrange for there to be a review of any other case involving an adult in its area with needs for care and support (whether or not the local authority has been meeting any of those needs).
Who makes the referral to the SAB for a SAR?
Anyone in Adult Social Care can refer a case to Surrey SAB for consideration for a SAR, but there are the following expectations:
- That, unless there is good reason to do otherwise, there should be a s42 enquiry before there is a SAR. This is because a s42 enquiry can address issues that a SAR cannot, such as accountability and redress, which need to be resolved before moving on to lessons being learned
- That, unless there is good reason to do otherwise, consideration for referral for a SAR will happen after the s42 enquiry is concluded. This is because it is necessary for the s42 enquiry to have achieved the objective of establishing the facts before lessons can be identified and acted on
- At the conclusion of an adult safeguarding enquiry, the SAD should consider whether the matter should be referred to Surrey SAB (or the SAB in another area if relevant) for consideration for a SAR
- Where a member of Adult Social Care staff is proposing to refer a matter to Surrey SAB (or the SAB in another area if relevant) there should be consultation with the Head of Adult Safeguarding. This is only for the purposes of supporting those making referrals for SARs to ensure the referrals give all the information needed to enable the Board to decide whether a SAR is required. The Head of Adult Safeguarding cannot veto a decision by anyone in Adult Social Care to make a referral to a SAB for consideration of a SAR.