2.4 Stage 1: Alert
In Leicester, Leicestershire and Rutland all alerts should usually be made to the lead agency, which is Leicester City Council, Leicestershire County Council or Rutland County Council, depending on the individual’s place of residence. The exception to this will be those which relate to abuse / neglect in either University Hospitals of Leicester (UHL) or Leicestershire Partnership Trust ( LPT), where alerts should be raised with the relevant lead safeguarding nurse in each organisation who will then liaise with the responsible local authority regarding whether the threshold for conducting a safeguarding enquiry is met and if so how this should be managed (see Section 42 in Health Care Settings, in Local Guidance and Templates).
Alerts relating to abuse / neglect in respect of other NHS staff / settings should be raised with the lead agency in the normal way.
The primary responsibility for coordinating information in response to a safeguarding adult concerns lies with the lead agency i.e. the local authority. However the local authority can delegate parts of the enquiry to other organisations whilst retaining overall responsibility for leading this (see also Thresholds).
2. Definition of an Alert
An alert is made with the lead agency for the safeguarding process to raise concerns that an adult is experiencing, or at risk of abuse or neglect. An alert may arise as a result of a disclosure, an incident, or other signs or indicators.
3. Purpose of an Alert
The purpose is to bring the concern to the attention of the lead agency for the safeguarding process.
An alert must always be made when the person is an adult and there is a concern that they are being, or are at risk of being abused or neglected, and are at risk of, or have experienced harm
4. Roles and Responsibilities
An alert can be raised by anyone including the person at risk, family, friends, professionals and other members of the public.
Immediate action may be required to safeguard the adult, when they request this or when they cannot safeguard themselves.
Contact should be made to the lead agency for safeguarding within the same working day.
If the incident occurs outside of normal working hours and cannot wait for a response until the next working day, it should be reported to the Emergency Duty Team (EDT).
The following guidance is primarily intended for people working (paid and / or unpaid) with adults at risk of harm, but anyone may use it as guidance to protect individuals from harm.
6.1 Acting to protect the adult and deal with immediate needs
- Make an immediate evaluation of the risk and take steps to ensure that the adult is in no immediate danger. Consider whether a protection plan is required. Are there any other adults who need safeguarding? Evaluate the risk to them and the need for a protection plan. Where appropriate, dial 999 for an ambulance if there is need for emergency medical treatment.
- Consider supporting and encouraging the adult to contact the police if a crime has been or may have been committed. If the adult is unable or unwilling to contact the police, immediate consideration must be given as to whether this needs to be done on their behalf, in their best interest or in the interest of others who may be at risk.
- Do not disturb or move articles that could be used in evidence, and secure the scene (for example, by locking the door to a room).
- Contact the Children and Families Department if a child is also at risk.
- Any possible steps should be taken to ensure that other service users are not at risk.
6.2 Responding to an adult who is making a disclosure
- Assure them that you are taking them seriously.
- Listen carefully to what they are telling you, stay calm, get as clear a picture as you can, but avoid asking too many questions at this stage.
- Avoid asking leading questions
- Do not give promises of complete confidentiality.
- Explain that you have a duty to tell your manager or other designated person, and that the adult’s concerns may be shared with others who could have a part to play in protecting them.
- Reassure them that they will be involved in decisions about what will happen.
- Explain that you will try to take steps to protect them from further abuse or neglect.
- If they have specific communication needs, provide support and information in a way that is most appropriate to them.
- Do not be judgemental or jump to conclusions.
The guidance below primarily relates to social care and NHS organisations. For other people, including members of the public who may wish to raise an alert, please contact the local authority responsible for the area where the alleged abuse or neglect has taken place as soon as possible. If you think a crime has been committed please contact the police.
6.3 Reporting to line manager
- If you are concerned that a member of staff, or any other person including another service user has abused an adult, you have a duty to report these concerns. You must inform your line manager immediately. If your line manager is unavailable you should inform another appropriate manager within your organisation, or if this is not possible you should contact the local authority.
- If you are concerned that your line manager has abused an adult, you must inform a senior manager in your organisation, or another designated manager for safeguarding adults.
6.4 Taking immediate management action to identify and address the risk
- Once the concern has been raised with the appropriate manager, they must decide without delay on the most appropriate course of action. The availability of the manager should not delay the decision to raise an alert to the lead agency, and therefore there should be alternative arrangements should be in place if this is the case.
- Organisations should ensure that they have procedures in place to cover the role of the person who is the alerting manager when they are unavailable, on leave or where services operate extended or 24 hour cover.
- Health staff will need to refer to their trust’s procedures on serious incident reporting, clinical governance and safeguarding adults as well as these safeguarding adults policy and procedures.
6.5 Supporting immediate needs
In line with information sharing considerations, the alerting manager may need to take the following action.
- Make an immediate evaluation of the risk to the adult.
- Take reasonable and practical steps to safeguard the adult as appropriate.
- Consider referring to the police if the suspected abuse is a crime.
- If the matter is to be referred to the police, discuss risk management and any potential forensic considerations with the police.
- Arrange any necessary emergency medical treatment. Note that offences of a sexual nature will require expert advice from the police.
- If the person alleged to have caused the harm is also an adult who is experiencing or at risk of abuse or neglect, arrange for a member of staff to attend to their needs.
- Make sure that other people are not at risk.
- Take action in line with the organisation’s disciplinary procedures, as appropriate, if a member of staff is alleged to have caused harm.
6.6 Speaking to the adult
It may be appropriate for the manager or representative of the organisation to speak to the adult. Wherever possible this should be done in consultation with the local authority or police. In doing this, they should consider the following.
- Speaking to them in a private and safe place and informing them of any concerns. It is essential to ensure that the person alleged to have caused harm is not present.
- Getting their views on what has happened and what they want done about it.
- Giving them information about the safeguarding adults process and how that could help to make them safer.
- Explaining confidentiality issues for example how you may have to share information they give if the risk is high, other people are at risk or a crime has been committed
- Explain how they will be kept informed and how they will be supported.
- Identifying communication needs, personal care arrangements and access requests.
- Discussing what could be done to ensure their safety.
It is important to remember that you should try not to contaminate any ongoing enquiry / investigation. You should offer reassurance to the adult, and try and establish the facts. You should avoid asking any leading questions.
If it is felt that the adult may not have the capacity to understand the relevant issues and to make a decision, it should be explained to them as far as possible, given the person’s communication needs. They should also be given the opportunity to express their wishes and feelings.
It is important to establish whether the adult has the capacity to make decisions. This may require the assistance of other professionals. In the event of the adult not having capacity, relevant decisions and / or actions must be taken in the person’s best interests. The appropriate decision-maker will depend on the decision to be made.
It is vital that a written record of any incident or allegation of crime is made as soon as possible after the information is obtained. Written records must reflect as accurately as possible what was said and done by the people initially involved in the incident either as a victim, suspect or potential witness. The notes must be kept safe as it may be necessary to make records available as evidence and to disclose them to a court.
You must make an accurate record at the time, including:
- date and time of the incident;
- the appearance and behaviour of the adult;
- any injuries observed;
- exactly what the adult said, using their own words (that is, their account) about the abuse and how it occurred. Alternatively, this may take the form of exactly what has been reported to you;
- the views and wishes of the adult;
- any actions and decisions taken at this point;
- exactly what you saw if you witnessed the incident;
- a record of what any witnesses said;
- the name and signature of the person making the record.
The record should be factual. However, if it contains your opinion or an assessment, it should be clearly stated as such and be backed up by factual evidence. Information from another person should be clearly attributed to them.
If recording is done at a later date this should be indicated in the record.
Whenever a complaint or allegation of abuse is made, all agencies should keep clear and accurate records and each agency should identify procedures for incorporating, on receipt of a complaint or allegation, all relevant records into a file to record all action taken. In the case of providers registered with Care Quality Commission (CQC), these should be available to service commissioners and the CQC so they can take the necessary action.
Consideration must always be given to any records left in a victim’s own home particularly when the perpetrator has access as this will increase the level of risk.
6.8 Considering the person alleged to have caused harm
The alerter should not discuss the concern with the person alleged to have caused harm, unless the immediate welfare of the adult makes this unavoidable.
If the person causing harm is another service user, action taken could include removing them from contact with the adult. In this situation, arrangements must be put in place to ensure that the needs of the adult continue to be met as well as the needs of the person allegedly causing harm.
It is important to ensure that any staff or volunteer who has caused risk or harm is not in contact with service users and others who may be at risk (for example whistle blowers).
6.9 Alerting and sharing information with the lead agency
If the alert is raised by a member of staff (or a volunteer), it will normally be made by their line manager or the designated safeguarding adults lead. However, anyone can make an alert to the lead agency and should do so in situations where, for example, discussion with a manager will involve delay in a high risk situation or where the person has already raised concerns with their manager but no action has been taken.
As well as deciding whether or not to raise an alert, the alerting manager must also decide whether to follow other relevant organisational reporting procedures. For example, NHS colleagues may still need to report under clinical governance or serious incident processes. Where an alert indicates that a member of staff may have caused harm, referral to the organisation’s disciplinary procedures should also be considered.
6.10 Factors to consider
- Is there any doubt about the mental capacity of an adult to make decisions about their own safety? Remember capacity can be undermined by the experience of abuse and where the person is being exploited, coerced, groomed or subjected to undue influence or duress.
- How vulnerable is the adult?
- What personal, environmental and social factors contribute to this?
- What is the nature and extent of the abuse?
- Is the abuse a real or potential crime?
- How long has it been happening? Is it a one-off incident or a pattern of repeated actions?
- What impact is this having on the individual? What physical and/or psychological harm is being caused? What are the immediate and likely longer-term effects of the abuse on their independence and wellbeing?
- What impact is the abuse having on others?
- What is the risk of repeated or increasingly serious acts involving the person causing the harm?
- Is a child (under 18 years) at risk?
If in any doubt the alerting manager should make contact with the lead agency to discuss the situation.
6.11 Obtaining consent
The mental capacity of the adult and their ability to give their informed consent to an alert being made and action being taken under these procedures is significant but not the only factor in deciding what action to take.
The test of capacity in this case is to find out if the adult has the mental capacity to make informed decisions:
- about a alert;
- about actions that may be taken under multi-agency safeguarding adults policy and procedures;
- about their own safety, including an understanding of the potential for longer term harm as well as immediate effects; and
- an ability to take action to protect themselves from future harm.
6.12 Alerting without consent
If there is an overriding public interest or vital interest, or if gaining consent would put the adult at further risk, an alert must be made. This includes situations where:
- the individual could be at risk of further harm;
- other people including children could be at risk of harm;
- it is necessary to prevent crime or if a serious crime may have been committed;
- there is a high risk to the health and safety of the adult;
- the person lacks capacity to consent.
The adult would normally be informed of the decision to alert and the reasons for this, unless telling them would jeopardise their safety or the safety of others.
If the adult is assessed as not having mental capacity to make decisions about their own safety and to consent to an alert being made, the alerting person or manager must make a decision in their best interests in accordance with the provisions set out in the Mental Capacity Act 2005. If it is suspected that the adult lacks capacity around these issues, a decision to alert should be made as soon as possible using best interest principles if the adult or others are at risk on an immediate basis.
The key issue in deciding whether to make an alert is the harm or risk of harm to the adult and any other adults who may have contact with the person causing harm or with the same organisation, service or care setting.
If the alerting manager is unsure whether to alert they should contact the relevant Safeguarding Adults Single Point of Contact for Adult Social Care for advice.
6.13 Evidence gathering and victim care
The police will always be responsible for the gathering and preservation of evidence to pursue criminal allegations against people causing harm and should be contacted immediately. However, other organisations and individuals can play a vital role in the preservation of evidence to ensure that vital information or forensics is not lost. The police are required to obtain oral (spoken) evidence in specific ways; particularly for some vulnerable witnesses whose evidence has to be obtained using ‘special measures’.
6.14 Preserving evidence
The first concern must be to ensure the safety and wellbeing of the alleged victim. However, in situations where there has been, or may have been, a crime and the police are called they will be responsible for the gathering of forensic and other evidence. The police will attend the scene, and agencies and individuals can play an important part in ensuring that evidence is not contaminated or lost. Remember that evidence may be present even if you cannot actually see anything.
- Try not to disturb the scene, clothing or victim if at all possible.
- If the allegation or disclosure concerns a possible rape or sexual assault, try to discourage the adult from washing, showering or bathing, or from washing their clothes.
- Secure the scene (for example lock the door).
- Preserve all containers, documents and locations.
- If in doubt contact the police and ask for advice.
6.15 Who else should be informed apart from the lead agency?
Where relevant the alerting person or manager should consider informing:
- the unit or service manager responsible for the management of the service;
- the Safeguarding adults lead in the organisation or service;
- the police, if a crime has been, or may have been, committed;
- Care Quality Commission (CQC) if the adult is living in a care home, receiving personal care or another registered resource or service;
- the relevant children and families team if children are also at risk from harm;
- It may also be appropriate to inform the family of the adult. However, wherever this should be discussed with the lead agency.
6.16 Supporting staff
Managers are responsible for:
- supporting any member of staff or volunteer who raised the concern;
- enabling and supporting relevant staff to play an active part in the safeguarding adults process;
- ensuring that any staff delivering a service to the adult are kept up to date on a need to know basis and do not take actions that may prejudice the enquiry;
- considering whether disciplinary processes need to be instigated if the person allegedly causing harm is a member of staff.
7. Anonymous alerts
7.1 Paid employees and volunteers
While every effort will be made to protect the identity of workers who are raising concerns, the anonymity of alerters cannot be guaranteed throughout the process. It is particularly important to remember the following:
- in cases where the police are pursuing a criminal prosecution, workers may be required to give evidence in court;
- all information from the adult safeguarding and disciplinary enquiry and investigation will be shared with the person identified as causing harm where a referral to the Disclosure and Barring Service is made;
- there is a possibility that a worker may be asked to give evidence at an employment tribunal;
- anybody can be requested to give evidence when the employer has referred a member of staff to a professional body such as the Nursing and Midwifery Council, the Health Care Professionals Council or the General Medical Council;
- the person causing harm may request to see information held about them under the Data Protection Act 1998;
- where the alerting person is part of a professional body, it is expected that they will not request anonymity.
7.2 Members of the public
It is preferable to know who is making the alert. However, a member of the public cannot be made to give their personal details. If the identity of the referrer has been withheld, the alert will be processed in the normal way, but this may make it more difficult to proceed to an enquiry. For example if further information is required in order to ascertain whether the safeguarding alert meets safeguarding thresholds or where there is not sufficient information to identify the adult/s at risk.
8. Fact Finding for the Alert by the Lead Agency
8.1 Gathering initial information and clarify facts
On receipt of an alert the lead agency should take the following action.
- Clarify basic facts, including who is involved in the allegation. Practitioners must be aware that this is not an enquiry, but that facts are being collected and / or clarified to enable decisions to be made about the level of risk and the process to be followed. This could involve contact with the alerter and a brief discussion with the adult, but would usually not involve contact with the person alleged to have caused harm. If it is felt that contact needs to be made with the person alleged to have caused harm in order to safeguard adults who may be at risk, this should be agreed by a manager from the lead agency.
- If the allegation concerns a potential crime there must be immediate liaison with the police to avoid contamination of evidence.
- Other relevant organisations should be informed of the nature of the allegation and the actions being taken.
- Previous contacts and history should be checked for both the adult and the person alleged to have caused harm, including any information about possible risks to workers visiting.
Where possible, include as much information under the following headings.
Details which may be taken from the alerter:
- name, address and telephone number;
- relationship to the adult;
- name of the person raising the alert if different;
- name of the organisation, if the alert is made from a care setting;
- anonymous alerts will be accepted and acted on as far as possible. However, the referrer should be encouraged to give contact details.
Details of the adult
- name, address and telephone number;
- date of birth, or age;
- details of any other members of the household including children;
- information about the primary care needs of the adult (i.e. disability or illness);
- funding authority, if relevant;
- ethnic origin and religion;
- gender (including transgender and sexuality);
- Communication needs due to sensory or other impairments (including dementia), including any interpreter or communication requirements;
- whether the adult knows about the alert;
- whether the adult has consented to the alert being made and, if not, on what grounds the decision was made to raise the alert;
- what is known of the person’s mental capacity;
- what are their views about the abuse or neglect;
- what they want done about it (if that is known at this stage);
- details of how to gain access to the person and who can be contacted if there are difficulties.
Information about the abuse, neglect, self-neglect or harm:
- How and when did the concern come to light?
- When did the alleged abuse occur?
- Where did the alleged abuse take place?
- What are the details of the alleged abuse?
- What impact is this having on the adult?
- What is the adult saying about the abuse?
- Are there details of any witnesses?
- Is there any potential risk to anyone visiting the adult to find out what is happening?
- Is a child (under 18 years) at risk?
Details of the person alleged to have caused the harm (if known):
- Name, age and gender
- What is their relationship to the adult?
- Are they the adult’s main carer?
- Are they living with the adult?
- Are they a member of staff, paid carer or volunteer?
- What is their role?
- Are they employed through a personal budget?
- Which organisation are they employed by?
- Are there other people at risk from the person causing the harm?
Any immediate actions that have been taken
- Were emergency services contacted? If so, which?
- What action was taken?
- What is the crime number if a report has been made to the police?
- Details of any immediate plan that has been put in place to protect the adult from further harm;
- Have children’s services been informed if a child (under 18 years) is a risk?
The alerting agency may be asked to confirm the alert in writing if this is a locally agreed requirement. If all the above information is not available, the alert should still be made. If in doubt, always make the alert.
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