July 2024: This section has been updated throughout and a new Appendix 1, Safeguarding Teams and Appendix 2, Oversight Process S42 NHS Enquiries Flowchart have been added.
RELEVANT SECTION
CONTENTS
1. Introduction
This guidance aims to clarify the local authority (LLR) oversight arrangements for safeguarding enquiries 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). The LLR Safeguarding Adults Thresholds Guidance should form the basis of the decision-making process once the safeguarding incident is reported.
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.
UHL or LPT safeguarding teams are likely to undertake the majority of S.42 enquiries, with oversight of the responsible local authority. The enquiry is 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 (see Making Safeguarding Personal). 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 these 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, and seek authorisation to conduct a safeguarding enquiry.
The local authority representative must then decide if the threshold for an enquiry is met and notify the UHL / LPT representative via email, within one working day. The LA representative records the details on their information systems.
UHL / LPT representatives should use the LLR Thresholds Guidance to inform their decision making.
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 discussion should also include a decision as to whether all or parts of the enquiry should be undertaken by the NHS Safeguarding Teams or whether the Local Authority will undertake this. Situations where the local authority is likely to undertake the enquiry could include where there is a perceived conflict of interest, or where wide scale abuse or neglect is suspected.
At this stage the responsible local authority will open a safeguarding enquiry on LiquidLogic and record 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 framework.
It is important to note that the safeguarding and patient safety 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.
* 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 representative 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
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 S.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 LLR Information Sharing Agreement and working to the principles of the Care Act.
Appendix 1: Safeguarding Teams
LPT Adult Safeguarding Team
Copy of Ward Information for Safeguarding
- Cover all Adult Mental Health (AMH) 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
- LGH – Clarendon and Beechwood wards
UHL Safeguarding Team
Cover: LGH, GH and LRI including the Emergency Department based at LRI. But not the Bradgate Unit or the Bennion Centre which are close to the Glenfield acute hospital but are part of LPT’s MH services.
Also, not the Evington Centre, which is close to the Leicester General acute hospital but is part of LPT’s MH services.
