November 2018: This chapter has been amended as a result of local review.
- 1. Strategy Discussion or Meeting
- 2. Participation
- 3. The Adult who is Experiencing or is at risk of Abuse or Neglect
- 4. The Person allegedly causing Harm
- 5. Decision Making
- 6. Specific Decisions regarding the Adult
- 7. Specific Decisions when the Person alleged to have caused harm is also an Adult with Care and Support Needs
- 8. Possible Outcomes
- 9. Recording and Sharing Information
- 10. Duty of Care
- 11. Capacity
- 12. Responding to Adults, Family Members, Friends and Neighbours who make Repeated Allegations
- 13. Large Scale Enquiries
- Appendix 1: Enquiry Process
1. Strategy Discussion or Meeting
The strategy stage could be a discussion (telephone or face to face) or a meeting. The lead agency will decide which approach is most appropriate.
A discussion would take place when:
- holding a meeting would involve a delay and place the person at greater risk;
- where the concerns are assessed to involve a low / medium risk of harm and / or a minimal number of organisations are involved and a meeting is not necessary to ensure that a protection plan is put in place.
If a discussion is held, it may still be necessary to hold a follow up meeting when the enquiry is deemed complex and / or there is a high risk of harm. A strategy discussion should always take place with 24 hours of the alert being received. Within this discussion there should be consideration of any actions required to respond to immediate risks within the situation and also which other agencies need to be involved in the safeguarding enquiry, and how the views of the adult will be established.
Where immediate action is needed to protect the adult, the information should be passed to the organisation that is in the best position to carry this out as quickly as possible. Agreement should be reached on what action will be taken.
A meeting may be held when the concerns are assessed to involve medium / high risk of harm and several organisations are involved. The strategy meeting should take place within five working days of the decision to proceed to a safeguarding enquiry (as outlined above the strategy discussion should still take place within 24 hours). This is to enable time for the adult’s views to be established and for them to attend the meeting if they wish to, and also to give the best opportunity for all relevant agencies to attend.
The responsible agency should ensure that any information shared with other agencies is:
Attendance at the strategy meeting should be limited to those who need to know and can contribute to the decision making process. Participants will be individuals from any organisation who have a role in investigating the allegation of abuse and / or in the assessment of the risk to the adult, or in relation to the person alleged to be causing the harm.
Every effort should be made prior to the meeting to explain its purpose to the adult and to discover their concerns, what they wish to happen and how they want to be involved in what is decided. Wherever possible, the adult should be invited to the meeting. If they do not wish to or are unable to attend then the meeting must decide who will feed back any decisions made to the adult.
Participants should have sufficient seniority to make decisions at the meeting, particularly concerning their organisation’s role and the resources they may contribute to the agreed protection plan.
The list below is not exhaustive and participation at a strategy meeting should be decided on the circumstances of the case. However, as well representatives of the lead agency, a meeting may be attended by:
- an involved health professional (for example GP, district nurse, community mental health nurse);
- the police, if there are concerns that a crime has been committed;
- if appropriate, a representative of the organisation who made the alert;
- an officer from the Care Quality Commission in line with its safeguarding adults protocol with regard to regulated services;
- Independent Mental Health Advocate (IMCA) or other advocate (if an IMCA has not been instructed a decision must be made as to whether to do so; an organisation that does not have authority to appoint an IMCA should discuss this with the relevant manager, who can ensure that one is instructed as necessary);
- other staff from adult social care who have a role to play/relevant involvement;
- the manager of an involved provider service unless they are named in the allegation, in which case a senior representative of the organisation would be invited;
- a representative from the funding authority if different to where the harm occurred;
- a representative of the council legal department or a client affairs officer;
- a representative of any other organisation which has a role to play;
- a child protection coordinator if there are also child protection concerns;
- a commissioner or member of quality compliance / contracting monitoring team.
However, appropriate attendance of strategy meetings should be considered on an individual basis, and it may be equally as appropriate for only one or two agencies to be involved.
Any organisation requested to attend a strategy meeting should regard the request as a priority. If no one from the organisation is able to attend, they should provide information as requested and make sure it is available at the meeting. The strategy discussion / meeting will need to decide on a number of issues, as listed below.
3. The Adult who is Experiencing or is at risk of Abuse or Neglect
See also Making Safeguarding Personal
The key issues of risk faced by the adult should be clarified:
- establish the facts of what has happened;
- assess the needs of the vulnerable adult for protection, support and redress;
- make decisions to what follow up action should be taken with regard to the perpetrator and the service or its management if they have been culpable, ineffective or negligent;
- decide who will interview and record the account of the adult, with timescales;
- if the adult is not present, decide who will ensure the adult is involved in the process to the maximum of their willingness and ability, and how this will be achieved;
- decide who will support the adult in a formal enquiry and ensure that their needs for support and protection are met;
- clarify the mental capacity of the adult to make decisions about their own safety;
- arrange for an assessment by the most appropriate person, if required;
- if the person does not have mental capacity, decide how they will be supported to be involved as much as they are able, who is a suitable person to act in the person’s best interests and whether an IMCA should be instructed;
- identify whether the person needs advice, support, assistance or services;
- identify any communication needs of the adult;
- identify any equality issues that need to be addressed;
- identify who will keep the adult informed and what information can be shared with them;
- where the adult has capacity, ensure their wishes are respected as to sharing of information with relatives and/or carers (unless there is a duty to override their decision).
4. The Person allegedly causing Harm
If it is suspected a criminal offence has taken place, advice must be sought from the police as to when it would be appropriate to speak to the person allegedly causing the harm.
Decide who will interview the person allegedly causing harm and / or give them information about the allegations (and when this should happen). This may well be the interviewing officer of the organisation that has a duty to investigate.
The local multi-agency Information Sharing Agreement should be consulted within this process (see Information Sharing).
The primary concern must be the safety of the adult, but the person allegedly causing harm also has rights which need to be considered. Decisions about notifying the person allegedly causing harm need to be made at the strategy meeting, weighing up potential repercussions or further risk of harm, also in agreement with the police where there is or may be a criminal investigation.
If the person allegedly causing harm is also an adult with needs for care and support, a decision must be made about how their needs are to be met during the enquiry. For example, if they lack capacity, they will also need someone who can represent them, possibly an IMCA.
Identify whether the person needs advice, support, assistance or services.
A decision should be made whether an organisation in which the alleged abuse or neglect has occurred may undertake an enquiry on the basis of an assessment of risk and harm to the adult.
4.1 If the alleged person causing harm is an employee
Based on the outcome and where appropriate, employers should report workers to the statutory and other bodies responsible for professional regulation such as the General Medical Council and the Nursing and Midwifery Council. If someone is removed from their role providing regulated activity following a safeguarding incident the provider has a legal duty to refer to the Disclosure and Barring Service (DBS). The DBS must also be informed if the person leaves their role to avoid a disciplinary hearing following a safeguarding incident and the employer feels they would have dismissed the person based on the information provided. It is a legal duty to make a safeguarding referral to DBS if a person is dismissed or removed from their role due to harm to a child or an adult.
5. Decision Making
Safeguarding enquiries can involve more than one line of inquiry, and these need to be discussed and carefully coordinated at the strategy stage. Where a criminal investigation is taking place decisions must be reached in a strategy discussion or meeting between the police and other involved organisations about what actions they can take and when. This ensures that the criminal investigation is not compromised and that the lead agency and other organisations are able to take necessary action to manage any risk within the situation.
Any organisation responsible for all or part of the enquiry should have regard to their other responsibilities or legal powers in relation to employment law, criminal law and clinical governance. The person identified to undertake the enquiry will be designated as the ‘investigating officer’ for the purpose of the safeguarding adults process. A decision must be made about who will receive all information and any reports that are subsequently produced.
6. Specific Decisions regarding the Adult
See also Making Safeguarding Personal
Always consider and reach agreement on the following areas with a strategy meeting or discussion:
- identification of who should be involved in the enquiry and the development of an interim protection or safety plan;
- the potential risk to the person being harmed;
- the risks to others from the person alleged to have caused harm;
- whether any action is required concerning the person alleged to have caused harm;
- whether there is likely to be a criminal prosecution (if known at this point);
- what information needs to be shared and with whom;
- whether there may be a number of enquiries / investigations by different organisations;
- whether there may be legal or regulatory action;
- whether the allegation involves a member of staff / volunteer or the safety of a service;
- whether the situation could attract media attention.
Remember to ensure that the desired outcomes of the adult are part of the discussion
7. Specific Decisions when the Person alleged to have caused harm is also an Adult with Care and Support Needs
The primary focus of the strategy meeting or discussion is the adult. Therefore it may be necessary to hold a separate multi-agency meeting to meet the needs and address the behaviour of the person alleged to be causing the harm. Whether or not this is the case the initial meeting must cover the following issues.
- how to coordinate action in relation to the adult alleged to be causing the harm;
- identification and allocation of a separate care manager / care coordinator in order to ensure that their needs are met and that a care plan is devised to ensure that other adults are not also put at risk by the person’s actions;
- whether there is likely to be a criminal prosecution (if known at this point);
- what information needs to be shared, and with whom;
- cases where the person alleged to have caused harm are a family member, friend or carer need to be treated with particular sensitivity. For example, work may need to be done to make sure the person alleged to have caused harm understands what abuse is;
- A carer will usually be entitled to and may need a carer’s assessment.
8. Possible Outcomes
If a decision is taken at the strategy stage to continue with an enquiry under the procedures, agreement should be reached on the following areas:
- whether the strategy or risk assessment will need to be reviewed during the enquiry and if so when;
- the enquiry should begin as soon as possible after the strategy meeting or discussion. Timescales will be agreed at strategy stage, this must be agreed by all relevant organisations and a record made of this decision. The responsible agency must inform the lead agency as soon as possible if they are unable to complete their action within the agreed timescales;
- provisional date for the case conference.
Other enquiries and processes could be triggered by a safeguarding referral. Different situations can be risk assessed and investigated by various agencies, and these should be clearly agreed at the strategy discussion/meeting.
9. Recording and Sharing Information
See also Information Sharing
A record should be made of the decisions and actions agreed.
Minutes of the meeting will be distributed within agreed timescales at the meeting. Regard should be given to confidentiality and data protection issues.
The information should not be shared for any purpose other than the protection and care of the adult/s at risk of abuse and / or neglect. Ownership of all documentation in relation to the enquiry sits with the agency leading the enquiry; agreement should be sought in relation to wider information sharing.
When an employer is aware of abuse or neglect in their organisation, then they are under a duty to correct this and protect the adult from harm as soon as possible and inform the local authority, Care Quality Commission and the local clinical commissioning group. The local authority has a duty to make whatever enquiries it deems necessary to decide what if any action needs to be taken and by whom. The local authority may well be reassured by the employer’s response so that no further action is required. However, the local authority must be satisfied that the employers response has been sufficient to deal with the safeguarding issue and, if not they will undertake an enquiry of its own and take any appropriate follow up.
10. Duty of Care
Duty of Care is defined simply as a legal obligation to:
- always act in the best interest of individuals and others;
- not act or fail to act in a way that results in harm;
- staff should act within their competence and not take on anything they do not believe they can safely do.
When acting in an adult’s best interests staff must do so with the adult’s consent unless they have evidence that the person lacks capacity to make that particular decision at the time it needs to be made.
In the following situations, action should be taken under the safeguarding adults procedures even if the adult does not want any action taken. The adult should be informed of the decision, the reason for it and be reassured that wherever possible no actions will be taken which affect them personally without their involvement:
- the adult may not have the mental capacity to make decisions about their own safety;
- the person causing the harm is a member of staff, a volunteer or someone (including another service user) who has ongoing contact with the adult;
- other people are may be at risk from the person causing harm; this is always the case if they are children or other adults who may require safeguarding.
11.1 When the Adult Lacks Mental Capacity to Consent
Where there is concern that the adult may not have mental capacity to make relevant decisions regarding the enqiry, it is important that their capacity is appropriately assessed as soon as possible. It may be established that, with appropriate support, they are able to make their own decisions.
If it is established that the adult lacks capacity to make decisions related to the enquiry, feedback will be given to them and anyone who is acting in their best interests (for example, their attorney or court appointed deputy), unless they are implicated in the allegation.
If the person has no suitable family or friend who can be consulted regarding their best interests, an independent advocate or an Independent Mental Capacity Advocate (IMCA) should be instructed in line with the local IMCA referral policy. An IMCA may be instructed if it is thought that it will be beneficial to the adult, even if they have family, friends and carers available to consult.
The managing officer must ensure that contact is made with a carer or personal representative. The managing officer will also decide in consultation with other relevant organisations what will be fed back at this point to the person causing the harm.
11.2 When the Adult has Capacity
If the adult has mental capacity to make decisions about their safety, consideration must be given to:
- finding out from them what is happening;
- talking to them about their concerns;
- carrying out a risk assessment with them to find out if they understand the risk and what help they may need to support them to reduce the risk if that is what they want;
- being satisfied that their ability to make an informed decision is not being undermined by the harm they are experiencing and is not affected by intimidation, misuse of authority or undue influence, pressure or exploitation if they decline assistance;
- reassuring them that they will be involved and supported in all relevant decisions and actions that are taken to protect them and informing them that in certain circumstances action will have to be taken even if they disagree (for example, if a child or another adult is also at risk of harm).
12. Responding to Adults, Family Members, Friends and Neighbours who make Repeated Allegations
Allegations of abuse made by service user’s family members, friends and neighbours should be investigated without prejudice. However, where repeated allegations are made and there is no foundation to them and further Enquiry is not in the best interests of the adult, then local procedures apply for dealing with multiple, unfounded complaints.
13. Large Scale Enquiries
The large scale enquiry process is usually triggered when there are significant concerns and / or high levels of safeguarding activity within a particular setting or organisation which is providing services to adults.
The process is a coordinated multi-agency response designed to protect service users and ensure that any significant issues raised with a particular care provider are appropriately addressed.
The large scale enquiry process is not a replacement for individual safeguarding alerts and enquiries.
Appendix 1: Enquiry Process
1. Definition of a Strategy Discussion or Meeting
The strategy discussion or meeting is, where appropriate, a multi-agency discussion between relevant individuals involved in order to share information, plan and agree how to proceed with the enquiry, considering all the known facts. It can be face to face or by telephone.
2. Purpose of the strategy discussion or meeting
The purpose of the strategy discussion or meeting is:
- to assess the immediate risk to the person who is being harmed and ensure an interim protection plan is agreed to protect the adult who is experiencing or at risk of abuse of neglect whilst the enquiry is completed;
- to discuss the allegations, share information with all relevant parties and agree further enquiry required, and plan who is to investigate what in which order with agreed target dates for agreed actions;
- to consider the wishes of the adult, or if they lack mental capacity, their representative;
- to coordinate any further collection of information required about the abuse or neglect
- to consider what support is needed for the adult;
- to consider whether support is needed for the person alleged to be causing harm (particularly if they are also an adult);
- to consider if other adults are affected;
- to identify any possible personal safety issues for the person who will conduct the enquiry and plan to address these;
- to make a clear record of the decisions made and record what information has been shared;
- to agree a communication strategy including feeding back to the referrer;
- to consider whether a child (under 18 years) may be at risk and agree a referral to the children and families team;
- to agree whether it is appropriate to inform family members or other people connected to the adult of the concerns;
- to circulate decisions to all invitees within locally agreed timescales.
3. Roles and Responsibilities
3.1 Lead agency
The lead agency should ensure that a strategy discussion or meeting takes place involving appropriate agencies, and that this is recorded and decisions are circulated. The chair should be an appropriate manager, how senior the manager is required to be may depend on the nature of the enquiry, such as how large scale this may be. The meeting / discussion should also identify any support to be given to the investigating officer or team by staff from other agencies (for example, tissue viability nurses, police, housing, service provider).
An agreement must be reached at the meeting about the respective roles and responsibilities of organisations during the enquiry in terms of lead responsibilities, specific tasks, cooperation, communication and the best use of skills.
When allocating roles to other agencies within the enquiry, for example to care providers, the lead agency should consider whether there is any compelling reason why it is inappropriate or unsafe to do this. 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. If this is the case there may be a conflict of interest and it will be appropriate person for an external person, usually the investigating officer, to be appointed to investigate. Where there is or is likely to be a criminal investigation there should be discussion with the police at the earliest opportunity and coordination of processes to avoid prejudicing such investigations.
If there is going to be a police investigation that could lead to criminal proceedings, there should be early identification of the likely need for witness support and special measures made available to witnesses as required (see Safeguarding Adults – Witness Support).
If there are going to be a number of enquiry / investigation processes being undertaken, the meeting or discussion will decide in what order the various processes should take place.
Where joint enquiries or assessments are planned, there should be clear agreement between the organisations concerned as to their respective roles and responsibilities.
Non-police enquiries should always be led by a suitably experienced and competent worker.
It is the responsibility of the lead agency where the alleged abuse occurred to coordinate the enquiry process to avoid any duplication of work within the enquiry. Different types of enquiries may be undertaken simultaneously, therefore all staff leading these enquiries must keep in regular contact to ensure that one enquiry does not impact or interfere with any other.
No individual agency can delegate their statutory responsibility to another. Each agency must act in accordance with its duty of care to safeguard adults when it is satisfied that action is appropriate.
Agencies will have their own operational policies and internal procedures applicable to their staff, which should be read in conjunction with these procedures.
The managers within the lead agency are responsible for coordinating the safeguarding enquiry. The manager will ensure that:
- enough information is available to allow prioritisation and allocation of enquiries;
- the enquiry is allocated to a worker with the necessary competence and experience;
- supervision and support is available to the investigating officer;
- individual cases are monitored to ensure adequacy of protection measures;
- all enquiries / assessments are conducted in accordance with this procedure and anti-discriminatory practice.
The manager should agree the accuracy of all records of meetings and associated assessments, and any decision taken to close the enquiry.
3.1 The Investigating Officer
The investigating officer should be a suitably experienced and competent member of staff working under the supervision of a manager. Care must always be taken to ensure complete independence of the investigator from the adult and the person alleged to have caused harm. The investigating officer is responsible for leading and coordinating the safeguarding enquiry / assessment in line with the agreed decisions made at the strategy discussion / meeting. The enquiry should involve:
- face to face contact with the adult of harm wherever possible;
- ascertaining the views and wishes of the adult and providing appropriate support to them;
- undertaking an assessment of risk of harm;
- collating all evidence and information gathered and completing an investigator’s report.
3.2 The Police
Adults who are experiencing or at risk of abuse and neglect, are entitled to the protection of the law in the same way as all. Behaviour which amounts to abuse and neglect, for example assault and physical, sexual or psychological abuse, theft and fraud and certain forms of discrimination may also constitute specific criminal offences. If a local authority, other agency or individual believes that a criminal offence may have been committed then it must refer it to the police urgently.
Whether or not a criminal act is committed does not depend on the consent of the victim. Criminal investigation by the police takes priority over all other enquiries but not over the adult’s wellbeing. Close cooperation and coordination among the relevant agencies is critical to ensure safety and wellbeing is promoted during any criminal investigation process.
When the interview involves a suspect who is equally vulnerable, then there is an obligation to provide an Appropriate Adult.
If there is a possibility of criminal proceedings, it is important that repeat interviews are avoided as evidence can become contaminated. In such cases the police will direct any disclosure interview/s.
The interview should be planned in advance and a record made of the plan.
Achieving Best Evidence guidance, and the Youth Justice and Criminal Evidence Act 1999 (special measures) detail special measures which apply to vulnerable adults as victims. There are measures available to people under 18 years of age when giving evidence or information for the purpose of a criminal investigation.
In Leicester, Leicestershire and Rutland there is a Adult Referral Desk where the officers have more specialist knowledge of safeguarding adults enquires (see Stage 2: Lead Agency Decision using Safeguarding Threshold Guidance whether to proceed to Referral).
3.3 All organisations
Each organisation must designate a suitably experienced and competent member of staff to ensure that it carries out its role and responsibilities in the plan as agreed at the strategy stage. This will include ensuring that the organisation carries out agreed actions within agreed timescales.
In addition the designated manager in each organisation will ensure that:
- actions to safeguard adults are given top priority and are supported throughout the process;
- clear records are kept of any contact with, or actions taken to support or care for, the adult;
- there is support and supervision for staff carrying out this work;
- the organisation actively cooperates with other organisations taking part in the enquiry and risk assessment;
- the investigating officer is kept up to date and informed of any new information or changes in the situation or the plan as soon as possible;
- any agreed inquiries are completed within agreed timescales;
- written evidence is kept of any enquiry findings;
- a written report of the findings is prepared and sent to the person designated to receive any reports required at the case conference to contribute to the protection plan.