November 2023: Changes have been made to Section 2, Taking Action in relation to referring a safeguarding concern.
The purpose of this guidance is to clarify the local authority (LLR) oversight arrangements for safeguarding enquiries where the alleged abuse or neglect (as defined under the Care Act 2014) occurs in an NHS in-patient setting (defined as a setting wholly staffed and managed by NHS staff). This guidance does not cover community based safeguarding concerns involving NHS staff.
UHL or LPT safeguarding teams are likely to undertake the majority of S42 enquiries with oversight of the responsible local authority. This should include information gathering and consideration of thresholds, referral and the initial strategy discussion / meeting with the local authority, taking steps to address immediate risk and make safe and informing the police of a potential criminal offence. The LLR Safeguarding Adults Threshold Guidance (see Thresholds) should form the basis of the decision-making process. Wherever possible, the views and desired outcomes of the individual involved in the enquiry should be established in line with the principles of Making Safeguarding Personal (see Making Safeguarding Personal), or, where the individual has been assessed as lacking capacity, a decision taken in their best interest. If a referral for advocacy support is required, the LPT or UHL Safeguarding Team will contact the responsible local authority to facilitate this.
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. They should also refer the safeguarding concern to the responsible local authority. The NHS provider or local authority can at any point involve the ICB Designated Professionals (as per the Care and Support Statutory Guidance) via Leicestercityccg.email@example.com for cases which are complex or would benefit from additional safeguarding support / advice. NHS Providers will follow local processes for informing commissioners when an adult safeguarding enquiry is initiated within their service.
Contact should be made with the Emergency Duty Team (see Local Contacts) if advice or discussion is needed outside of Adult Social Care working hours.
The local authority in consultation with the referring agency should consider any immediate risks within 24 hours of the referral and hold a strategy discussion or meeting within five working days, in line with MAPP requirements. As well as planning the enquiry the strategy discussion should also include a decision as to whether all or parts of the enquiry should be undertaken by the NHS Safeguarding Teams with local authority oversight (referred to in Care Act guidance as the “causing the enquiry to be made”), or whether the local authority will undertake 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.
3. Suspected Neglect or Abuse
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 is likely to undertake the enquiry, including the chairing of strategy meetings, although it may still delegate specific aspects of the enquiry to others. 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).
Other situations where the local authority is likely to undertake the enquiry rather than cause the enquiry to be made include where there is perceived to be a conflict of interest, where wide scale abuse or neglect is involved, or if the alleged perpetrator is someone not working within the hospital – such as a family member or friend.
It is important to note that the safeguarding and serious incident processes may run in parallel and there needs to be a case by case 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 ICB at the start of the process to confirm roles, responsibilities and the plan of action.
4. The Process
Regular meetings will take place (no less frequently than once a month) between the UHL or LPT safeguarding representative and an agreed representative from the relevant local authority (Leicester City / Leicestershire County) to discuss progress on safeguarding enquiries. Due to the very low numbers of referrals for Rutland residents, and instead of a regular meeting, any new referrals will be discussed directly with the safeguarding lead and agreement reached on the most appropriate way forward.
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.
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 confirm and challenge 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 and if this is not possible the situation should be escalated to senior managers within each organisation.
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 at senior safeguarding lead level 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.
Information should be shared in line with the multi-agency LLR Information Sharing Agreement and working to the principles of the Care Act.
In situations where the local authority undertakes the S42 enquiry where the alleged abuse or neglect has occurred in an NHS in-patient setting, the relevant UHL or LPT safeguarding team should be kept fully informed of progress at the regular confirm and challenge meetings and may still be tasked with actions related to the enquiry.