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2.7 Stage 4: Case Conference

RELEVANT CHAPTERS

Stage 3: Undertaking Enquiries

Stage 5: Review

July 2015: This chapter has been revised to include conference report forms for agencies and GPs (see Appendix 1).

1. Definition of a Case Conference

A case conference is a multi-agency meeting held to discuss the outcome of the safeguarding enquiry, agree conclusions and to decide whether it is necessary to put in place a long-term protection or safety plan. Wherever possible the adult who is experiencing or at risk of abuse or neglect should be invited to, supported at and enabled to attend the case conference.

2. Purpose of a Case Conference

  • To consider the findings and outcomes of the enquiry.
  • To decide whether abuse took place.
  • To assess ongoing risk.
  • To produce or revise a protection plan.
  • To ascertain whether the adult is satisfied with the outcome of the enquiry.

3. Roles and Responsibilities

A manager from the lead agency should ensure that a case conference is convened, chaired and minutes taken (see local guidance for chairing arrangements).

In large scale enquiries a more senior / independent person may take the chair. The investigating officer will submit a report summarising the findings of the enquiry / assessment and will attend the case conference. Any reports made to date will be available to the meeting and will form the basis of discussion. Confidentiality arrangements relating to the reports should be clearly defined by the chair. Reports should not be shared with people who did not attend the conference without express permission of the chair.

4. Process

Wherever possible the adult should be involved and assisted to participate in the case conference. It is essential that the adult is given information about the purpose of the conference in advance, and who will be there. In some cases, in order to meet the access and communication needs of the adult (for example if specialist facilities are needed), a separate protection plan meeting could be held in a different venue. Such a meeting should be held on a date as close to the case conference as possible.

In some cases the conference will be divided into two parts where:

  • the information being discussed may compromise a future criminal investigation confidential or sensitive information relating to a third party needs to be discussed;
  • actions relating to the person alleged to have caused harm need to be discussed).

In such cases the first part of the meeting is attended by professionals only, and the adult and/or their representative will attend the second part. Alternative arrangements may also need to be considered if there has been a large scale investigation involving a number of adults at risk.

4.1 Who should attend?

  • The adult and / or their representative.
  • The chair
  • The investigating officer
  • A minute taker
  • A competent and experienced manager from each organisation involved
  • Representatives from any other relevant organisations who are able to contribute to the protection plan
  • The care manager, care coordinator or key worker for the adult at risk.
  • Any other relevant professionals (for example the police, CQC representative, service contracts / commissioning staff, GP, psychiatrist or other health care workers involved with the adult.
  • A representative from the Council’s legal department may also need to be invited.

If any relevant professional is unable to attend, they must provide their contributory information in writing to the meeting.

All those attending should have the delegated authority to agree to make decisions about the provision of resources and services that will contribute to the protection plan.

4.2 Involving the adult

The adult should be:

  • invited, supported and enabled to attend the case conference or equivalent part of the meeting as appropriate where it is safe for them to do so and they wish to participate
  • supported to play an active part in the development of their protection plan.

If the adult has capacity to make decisions about their own safety, their views should be taken into account about:

  • whether they wish to attend
  • whether they wish to attend and bring someone else with them
  • whether they wish to nominate someone to attend on their behalf and who this is.

If the adult has mental capacity but does not wish to attend the case conference, they should be consulted beforehand about their views and these should in turn be given at the meeting by a representative, advocate or key worker.

If the adult does not have capacity a decision needs to be made about who the key decision-makers should be, in line with the MCA Code of practice.

The meeting should be held at a venue which enables the adult to fully participate. In some cases this may be in their own home.

If the adult does not attend the meeting the reasons for this should be recorded.

The meeting should decide and record:

  • who will feed back any decisions about the protection plan to the adult if they do not attend
  • who they can contact if they do not agree with the protection plan or wish to comment on it.

4.3 Decisions about others who may wish to attend

Family members do not have an automatic right to attend a case conference and should only be invited at the express wish of the adult if deemed appropriate If the adult does not have capacity to make that decision, it may be made in their best interests, or with the consent of a Lasting Power of Attorney or Deputy appointed by the Court of Protection.

4.4 Conducting the case conference

The case conference will:

  • receive and consider the investigating officer’s report including the stated wishes of the adult at risk, and proposed outcomes of the enquiry;
  • receive and consider reports from other involved agencies;
  • evaluate the information in order to assess the levels of current risk/s;
  • determine on the balance of probabilities whether abuse has occurred;
  • assess the likelihood of risk reoccurring;
  • consider whether any further action or information is required;
  • consider whether legal advice and guidance is required;
  • consider whether any statutory/regulatory action is required (for example, referral to professional bodies and regulators);
  • review any existing protection plan to ensure it is relevant and appropriate, or agree a protection plan with the adult (or the person representing them or their best interests);
  • decide which organisation/s / individual/s will monitor and coordinate the protection plan;
  • agree contingency measures if the protection plan does not work;
  • agree how the protection plan will be shared with partners, taking into account information sharing considerations;
  • review any actions taken so far in relation to the person alleged to have caused harm and decide what further action is / may be needed for the adult and / or the person causing harm (protection and / or support plan);
  • decide what action is appropriate if the allegation has not been proved or was unfounded but concerns remain about potential risk;
  • provide support and services to meet the needs of the adult and their carer/s;
  • determine what additional information needs to be shared and with whom;
  • set a date for a review if there are concerns that the protection plan may not lead to a reduction of the risk or where the enquiry is incomplete at the time of the case conference;
  • agree whether a further case conference is required.

The fact that there is insufficient evidence for a criminal prosecution does not necessarily mean that action cannot be taken under civil proceedings (for example seeking an injunction) or disciplinary proceedings, because there are differing burdens of proof. Discussions about this may form part of the case conference, although final decisions may be made at a later date (e.g. it may not be possible to state with certainty that civil proceedings will take place or the final outcome of disciplinary investigations).

5. Outcomes

5.1 The protection plan

The safeguarding adults protection plan aims to remove or minimise risk to the person and others who may be affected, if it is not possible to remove the risk altogether. It will need to be monitored, reviewed and amended as circumstances arise and develop. Those attending the case conference will:

  • review any existing protection plan to ensure it remains relevant and appropriate, or agree a new or revised plan with the adult (or the person representing them or their best interests), and decide which organisation will monitor and coordinate the plan;
  • agree contingency actions if the protection plan does not work;
  • designate a protection plan coordinator (this is likely to be different to the role of the managing officer and may be a social worker);
  • agree how the plan will be shared with partners, taking information sharing considerations into account;
  • determine what additional information needs to be shared and with whom;
  • set a date for a review unless all the organisations involved agree that this can take place as part of the care management / care programme approach (CPA) or health and social care process;
  • set a review date if there are concerns that the protection plan may not lead to a reduction of risk or where the enquiry is incomplete at the time of the case conference;
  • ensure the protection plan is person centred focused.

The protection plan will not include actions taken against the person causing harm. Protection plans are case specific but are likely to include:

  • action to ensure the safety of the adult;
  • action to ensure the continued involvement of the adult and where appropriate their carer or advocate;
  • details of support services, treatment or therapy available to the adult at risk, either in the immediate or the longer term.

It is imperative that practical steps are taken to ascertain the wishes and views of the adult in relation to the protection plan.

5.2 Deciding to hold a separate protection plan meeting

Normally a protection plan will be agreed as part of the case conference. However, a separate protection plan meeting may be considered necessary if:

  • the strategy meeting decided that it was possible to agree a protection plan without a formal enquiry and a case conference;
  • the enquiry was complex or lengthy and there were confidentiality issues resulting in the adult being absent for a significant part of the meeting;
  • their interests would then be best served by having a separate meeting they are able attend;
  • there are clinical considerations regarding the person’s ability to engage in the process at a given time, as agreed by the agencies concerned;
  • the protection plan meeting needs to take place in the person’s own home or in another setting.

Supporting the person to make decisions about what can be done to help them will mean that they are given information about:

  • the process and the organisations that may be involved;
  • the actions that may be taken;
  • which organisations may be able to offer support;
  • what the risks may be from not taking any action and what to do if they change their mind at a later date (for example, if the abuse gets worse and they need help to reduce the risk of further harm).

The individual should also be offered the options of:

  • receiving emotional support if necessary;
  • taking part in activities which increase their ability to protect themselves;
  • making contact with a named organisation if they change their mind about the protection plan, or if they do not wish any further involvement.

5.3 Possible outcomes for the person causing harm, the provider or the organisation

  • criminal prosecution / formal caution (for example individuals, company directors);
  • police action;
  • offer of assessment / services;
  • removal from property / support, advice, services;
  • management of access to adult at risk;
  • referral to the Disclosure and Barring Service (DBS).

A referral to the DBS must be made by the regulated activity provider:

  • if they have withdrawn permission for the person (a member of staff or volunteer) to engage in regulated activity, or would have done so if the person had not resigned, retired, been made redundant or been transferred to a position that is not a regulated or controlled activity
  • if they think the person has:
    • engaged in relevant conduct or
    • satisfied the harm test (that is they have harmed or put at risk of harm the adult at risk)
  • if they have received a caution or conviction for a relevant offence.

Other potential outcomes are:

  • referral to regulatory body (for example, Nursing and Midwifery Council, Health and Care Professions Council, British Medical Association);
  • disciplinary action;
  • action by the Care Quality Commission (for example de-registration);
  • implementation of requirements made by the commissioner of services;
  • continued monitoring;
  • counselling / training;
  • referral to court mandated treatment;
  • referral to Multi-Agency Public Protection Arrangements (MAPPA) (see Domestic Violence and Abuse);
  • action under the Mental Health Act 1983 (as amended by the MHA 2007)
  • action by contract compliance (for example, suspension or termination of a contract by a commissioner);
  • exoneration;
  • no further action.

In addition, organisational changes may be implemented following a review (for example to staffing, recruitment, training, working practices and culture, improvement of risk monitoring and quality assurance). Changes may also be made in response to recommendations from any complaints process. Such changes can include the setting up of an Safeguarding Adult Review or serious incident process if there are concerns about the safeguarding adults process and / or interagency working by partners.

5.4 Information that may be shared with others

See also Information Sharing.

Where concerns have been identified about the quality of care from a particular provider, following the enquiry:

  • the CQC should be informed if a local authority or a health organisation has concerns about the standards of care within a community care setting;
  • factual information regarding concerns about standards of care can be shared with local authorities on a need to know basis where appropriate.

A report that is available to the public is produced annually to demonstrate the Safeguarding Adults Return (SAR) which is a mandatory collection that records information about individuals for whom safeguarding referrals were opened during the reporting period (also referred to as adults at risk) and case details (also referred to as allegations) for safeguarding referrals which concluded during the reporting period. The purpose of the collection is to provide information which can help stakeholders to understand where abuse may occur and improve services for individuals affected by abuse.

The SAR data is recorded by adult safeguarding teams based in the 152 councils with Adult Social Services Responsibilities in England. At the end of the reporting year these data are submitted to the Health and Social Care Information Centre (HSCIC) in an aggregate form through Omnibus, a secure online data collection system.

6. Recording and feedback

Staff must keep records in keeping with their organisational guidelines / processes.

6.1 Case conference minutes

Minutes should be recorded on the relevant local authority or agreed multi-agency pro forma and approved by the chair of the meeting. The minutes record the decisions of the case conference and evidence of how the decisions were reached. This may involve recording separate decisions and outcomes for each allegation.

The minutes should be circulated within agreed timescales to:

  • all attendees and invitees to the meeting;
  • all those contributing to the protection plan;
  • the CQC where the case conference relates to a service that it regulates;
  • all other relevant regulatory bodies, as appropriate.

Unless this would increase the levels of risk, a copy of the protection plan should be sent to the adult or, with their permission, to another person. If the adult does not have mental capacity, a decision should be made in their best interests about to whom to send the minutes. If the adult has attended the case conference then the minutes will be shared with them subject to an assessment of risk. Where there is information that cannot be shared, it should be deleted from any documents sent out. It is imperative that Data Protection Act 1998 principles are adhered to.

Where information is sent to a carer, with permission of the adult or in their best interests, the managing officer will decide what information can be shared about the person causing the harm.

Whether or not minutes of the meeting are sent to the adult, the managing officer will decide the most appropriate person to report back the outcome of the meeting. This should take place as soon as possible after the meeting. The adult should be enabled to raise any issues they may have about the decisions taken and the protection plan that has been developed and agreed upon.

Feedback should also be given to the person who made the referral, taking into account confidentiality and data protection issues.

6.2 Feedback to the person alleged to be causing the harm

A decision must be made at the meeting about what feedback should be provided to the person alleged to be causing harm and the organisation that employs that person (if relevant), and who should provide it. If the person alleged to be causing the harm does not have mental capacity (and is also an adult at risk), feedback will be given using the support of the person acting in their best interests.

Appendix 1: Report Forms

Click here to view Agency Report Form for Safeguarding Adults Case Conference

Click here to view GP Report Form for Safeguarding Adults Case Conference

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