4.2.1 Guidance for the Oversight Process of S42 Enquiries in NHS Settings

1. Introduction

Section 42 (2) of the Care Act states that ‘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’.

Therefore, this guidance aims to clarify the local authority (LLR) oversight arrangements when delegating Section 42 (Care Act, 2014) adult safeguarding enquiries to Leicestershire Partnership Trust (LPT) or University Hospitals of Leicester (UHL) Safeguarding Teams. Enquiries will only be delegated where the alleged abuse or neglect occurs in an NHS in-patient setting (defined as a setting wholly staffed and managed by NHS staff (see Appendix 1 for details). Enquiries must not be delegated when the incident occurs as a result of abuse or neglect by a family member or intimate partner/ex-partner (domestic abuse), or by carers/staff who are not employed by the relevant health Trust (such as carers employed by social care / care homes).

The Care Act 2014 (Section 42) should form the basis of the decision-making process once the safeguarding incident is reported, the LLR Safeguarding Adults Threshold Guidance (see Thresholds) should be used to support decision making and the Section 42 enquiry should be conducted in accordance with the local MAPP.  Wherever possible, the views and desired outcomes of the adult/s at risk involved in the enquiry should be established in line with Making Safeguarding Personal. If referral for advocacy support is required, the LPT or UHL Safeguarding Team will contact the responsible local authority to arrange this.

For the purpose of the Oversight Process, the responsible local authority is defined by the ordinary residence of the adult of risk. If the adult is ordinarily resident in or funded by an authority outside of LLR, then normal safeguarding arrangements would apply, and the responsible local authority would be defined by where the abuse occurred. The host local authority may request that UHL or LPT Safeguarding Team inform the funding authority about the concern

2. Taking Action

In line with the Multi-Agency Safeguarding Adults Policy and Procedures (MAPP), UHL or LPT representatives, usually directed by their Safeguarding Teams, should take any immediate action required to safeguard the adult and any other adults that may be at risk of immediate harm.

The UHL or LPT representative should then raise the safeguarding alert to the responsible local authority via email using the enquiry oversight template, within one working day. The template is also the mechanism for seeking authorisation to conduct a safeguarding enquiry on behalf of the responsible local authority.

If the local authority intends to undertake all or parts of the enquiry, then they must inform the relevant NHS Safeguarding Team within 24 hours of receiving the template. Situations where the local authority is likely to undertake the enquiry will include where there is a perceived conflict of interest, or where wide scale abuse or neglect is suspected. (Please see Section 3, below, for situations involving serious harm or death).

The local authority representative must then decide if the threshold for an enquiry is met and notify the UHL / LPT representative via email, within up to 5 working days. The local authority representative records the details on their information systems.

Contact should be made with the Emergency Duty Team (see Local Contacts) if urgent advice or discussion is needed outside of Adult Social Care working hours.

The relevant local authority, in consultation with LPT / UHL, should consider whether a strategy discussion is required to consider any immediate risks within 24 hours of the referral. This may not be required if adequate assurances have been provided by LPT / UHL within the oversight template.

The UHL / LPT Safeguarding Team will arrange a strategy meeting within 5 working days of receiving authorisation from the local authority to proceed with the Section 42 enquiry.

At this stage, the responsible local authority will record the decision on Liquidlogic stating that this enquiry is being undertaken using the oversight process.

3. Severe Harm or Death

Where severe harm or death* has occurred, and where it is suspected that neglect or abuse has contributed to, or caused this, the local authority may choose to undertake the enquiry, although it may still delegate aspects of the enquiry to UHL or LPT to investigate, for example under the national patient safety incident response framework.

It is important to note that the safeguarding and patient safety processes may run in parallel and there needs to be discussion by the relevant safeguarding leads in terms of cooperation, appropriate information sharing and timely progression of the processes. The same notification timescales apply if the local authority is made aware of a potential serious incident within a health setting. For situations where death or serious harm has occurred, the local authority should also liaise with the relevant Integrated Care Board (IRB) at the start of the process to confirm roles, responsibilities, and the plan of action.

* For the purpose of this guidance severe harm is defined as per CQC’s Duty of Candour guidance as “a permanent lessening of bodily, sensory, motor, physiologic or intellectual functions, including removal of the wrong limb or organ or brain damage, that is related directly to the incident and not related to the natural course of the service user’s illness or underlying condition” (see Duty of Candour).

4. The Process

Regular meetings will take place (no less frequently than once a month unless agreed by both parties in exceptional circumstances) between the UHL or LPT safeguarding representatives and an agreed representative from the relevant local authority (Leicester City / Leicestershire County) to discuss progress on safeguarding enquiries. For enquiries relating to Rutland residents, meetings will be arranged as and when required.

Details of progress made on existing referrals will be forwarded securely by UHL / LPT to the local authority at least one working day in advance of the arranged meeting, via the oversight spreadsheet.

The referrals will be recorded on a spreadsheet and be updated by the UHL or LPT Safeguarding Teams. The relevant local authority will also hold a copy of this securely, which will be updated following each oversight meeting.

At the point of conclusion of the enquiry, this information will be recorded in the local authority’s database and a brief closure report provided by UHL or LPT. The outcome of the enquiry should be jointly agreed. If this is not possible, the situation should be escalated to senior managers within each organisation. See also Escalation / Resolving Professional Differences.

If the local authority has concerns about how the enquiry is being undertaken this should be discussed with the UHL or LPT Safeguarding lead(s) in the first instance and actions to rectify this identified and agreed. If following this, the concerns remain; the local authority may choose to take over the enquiry.

Similarly, the UHL or LPT safeguarding lead can request the local authority take over an enquiry at any point if a timely progression is proving difficult, or for any other reason. This decision needs to be taken by the Head of Safeguarding for UHL and LPT and only after every effort has been made to resolve through informal processes, including the option for an independent peer / partner review, or a second clinical opinion where considered appropriate. In these circumstances, the responsible ICB should also be notified as mandated by NHS England as part of the commissioning process.

In situations where the local authority undertakes the Section 42 enquiry, the relevant UHL or LPT safeguarding team should be kept fully informed of progress at the regular oversight meetings and may still be tasked with actions related to the enquiry.

Information should be shared in line with the multi-agency Leicester, Leicestershire and Rutland Multi-Agency Overarching Safeguarding Information Sharing Agreement and Guidance and working to the principles of the Care Act.

Appendix 1: Safeguarding Teams

LPT Adult Safeguarding Team cover:

• All Adult Mental Health (AMH) wards
• Evington Centre, LGH – Clarendon and Beechwood wards
• Agnes Unit
• Hinckley and Bosworth – East/North wards
• Loughborough – Swithland
• Lutterworth – Fielding and Palmer
• Coalville Community Hospital
• Market Harborough – St Luke’s
• Rutland Hospital
• Melton Hospital

See also: Ward Information for Safeguarding (opens in excel)

UHL Safeguarding Team cover:

LGH, GH and LRI including the Emergency Department based at LRI, the Bradgate Unit and Evington Centre.

Appendix 2: Oversight Process S42 NHS Enquiries Flowchart

Oversight Process Section 42 NHS Enquiries Flowchart (opens as a PDF)