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Executive Strategy Process

Introduction

Darlington Safeguarding Partnership (DSP) is the statutory body that sets the strategic direction for safeguarding and is responsible for protecting adults who are experiencing, or who are at risk of abuse or neglect living in Darlington.  Everyone has a responsibility to take a ‘Think Family’ approach, which requires all agencies to consider the needs of the whole family from working with individual members of it, making sure that support provided by children, adults and family services is coordinated and takes account of how individual problems effect the whole family.

The Care Act 2014 created a new legal framework for Adult Safeguarding, this included a focus on concerns of Organisational Abuse. The Care and Support Statutory Guidance outlines that safeguarding is not a substitute for:

  • providers’ responsibilities to provide safe and high quality care and support
  • commissioners regularly assuring themselves of the safety and effectiveness of commissioned services
  • the Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action
  • the core duties of the police to prevent and detect crime and protect life and property

The statutory guidance also states that one of the aims of safeguarding is to clarify how responses to safeguarding concerns derived from the poor quality and inadequacy of service provision, including patient safety in the health sector, should be responded to.

Definitions

Serious Concern - A single issue, or an accumulation of issues in relation to the operation of a care provider, or the quality of care provided by an organisation, which puts service users, staff or visitors to the service at serious risk.

Organisational Abuse - Includes neglect and poor care practice within an institution or specific care setting such as a hospital or care home, for example, or in relation to care provided in one’s own home. This may range from one off incidents to on-going ill-treatment. It can be through neglect or poor professional practice as a result of the structure, policies, processes and practices within an organisation.

Complex Case - A case that meets the criteria for a Safeguarding Adults Review, as defined by the Care Act 2014. Safeguarding Adults Boards (SABs) must arrange a Safeguarding Adults Review (SAR) when an adult in its area:

  • dies either as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult; or
  • has not died, but the Safeguarding Adult Board knows or suspects that the adult has experienced serious abuse or neglect, and there is concern that partner agencies could have worked more effectively to protect the adult.

Purpose

This Procedure sets out the framework for dealing with serious safeguarding concerns on a multi-agency basis whilst maintaining the focus on the adult(s) experiencing or, at risk of abuse or neglect. The purpose is to bring professionals from relevant agencies together to:

  • Share information and discuss concerns about a service provider, organisation or complex individual case of alleged abuse
  • Consider the level of risk and agree a proportionate response
  • Plan the investigative framework
  • Confirm the outcomes of any investigations
  • Formulate a multi-agency action plan
  • Conclude the process when the necessary changes/improvements have been made.

Scope

Who does the procedure apply to?

A provider, for the purposes of this procedure, is an organisation or institution which provides care to an individual or group of people. This includes, but is not limited to:

Care homes: including nursing and care home services provided ‘in-house’

  • Home Care Providers
  • Supported Living
  • Private hospitals
  • Day Services/ day opportunity Providers
  • Local Authority in-house provision
  • Rehabilitation Services
  • Voluntary agencies

This procedure does not apply to NHS Foundation Trusts as there are separate arrangements in place to manage serious concerns in these settings.

When does the procedure apply?

The procedure should be applied if a situation arises indicating there are serious safeguarding concerns about a service provided for adults. This procedure should also be used in conjunction with children’s services when it is identified that there is an indication of a serious safeguarding risk to service provision by providers of both adults and children’s services.

The DSP Adult Safeguarding Practice Tool [PDF Document] should be used to identify the level of seriousness of an individual concern and assist Adult Social Care services and other agencies in determining the most appropriate level of response to initial safeguarding adult concerns. It is important that the level of response to a safeguarding concern is kept under constant review and is proportionate, as additional information becomes available.

Indicators that trigger consideration for invoking this procedure include:

  • Serious concerns are raised following individual or multiple safeguarding enquiries/investigations
  • Contract compliance visits identify systemic issues within a care setting and there are significant concerns about the quality of care provided and the ability of the provider to improve the service
  • CQC inspections result in placing services into special measures, issuing warning notices or inadequate ratings for safety
  • Multi-agency concerns about systemic problems within a service or organisation
  • A series of safeguarding concerns are made about the same provider indicating that the provider is not operating a safe service
  • A safeguarding enquiry raises serious concerns about a service or organisation
  • A number of safeguarding allegations are made against more than one member of staff
  • A cluster of concerns are received about similar issues e.g. pressure ulcers; individuals not properly nourished or hydrated
  • It is alleged that a number of perpetrators are suspected of abusing or neglecting adults, experiencing, or at risk of abuse and neglect
  • A whistle-blower makes serious allegations about the management or regime of a service
  • An individual case of alleged abuse is serious or complex e.g. the alleged perpetrator holds a position of authority within a care setting/organisation
  • An individual case of alleged abuse meets the criteria for a Safeguarding Adults Review.

By invoking this procedure there can be a detrimental effect on the operating business of care providers. There is an expectation that commissioners will have procedures in place to actively monitor concerns at an early stage and ensure measures are taken to support the care provider to improve thereby minimising the escalation of risk and the need to apply this procedure.

The distinction between abuse and poor care practice is difficult to define and therefore any conclusion reached should be evidence based using the outcome of investigation/s and advice/information received from appropriate professionals and regulatory bodies.

When does the Procedure not apply?

Most safeguarding enquiries/investigations within provider services will not lead to a wider investigation under this procedure, although most cases could have implications for a larger group of adults than the individual at risk initially identified.

This procedure does not replace the normal contract compliance and quality assurance processes, although it may run alongside these.

The Care Act 2014 introduces responsibilities in relation to provider failure and other service interruptions. The Act imposes clear legal responsibilities on local authorities where a care provider fails. The Act also makes it clear that local authorities have a temporary duty to ensure that the needs of adults continue to be met if their care provider becomes unable to carry on providing care because of business failure, no matter what type of care they are receiving. This is regardless of whether the adult pays for their care themselves, the local authority pays for it, or whether it is funded in any other way. In these circumstances, the local authority must take steps to ensure that the adult does not experience a gap in the care they receive as a result of the provider failing. Therefore, there is a clear difference between business failures as defined by the Care Act 2014 and when a provider comes under this process due to the safety in the delivery of care and services from a safeguarding perspective. It should be noted that there may be instances in which a provider fails under the definition of provider failure within the Care Act and there are concerns relating to safeguarding and the quality of care. In these circumstances, agreement on which area will lead is to be negotiated, e.g. safeguarding or commissioning.

Procedure

Who decides whether the procedure applies?

Senior Managers and Heads of Service within Adult Services will inform the Director/Assistant Director for Adult Services, in consultation with other investigating authorities, who will make the decision to invoke this procedure.

Who should attend the initial serious concerns meeting?

It should be agreed who will attend the initial meeting, which may include any of the following, as and when appropriate but will particularly include those who hold relevant information and have had direct involvement with the service:

  • An Adult Social Care Senior Manager responsible for managing serious concerns about a provider (chairperson)
  • Adult Safeguarding Manager
  • Lead Commissioners
  • Officer/s responsible for any relevant individual safeguarding investigations or assessments
  • Care Quality Commission Inspector
  • Contracts Manager / Quality Assurance Officer
  • Representatives from Health care providers (e.g. acute trusts and mental health trusts)
  • Representatives from agencies funding placements within the service, including: Locality NHS Commissioners (formerly Clinical Commissioning Groups (CCGs)), other Local Authorities and Continuing Health Care (CHC)
  • Police representative
  • Local Authority legal representative
  • Children’s Commissioners Prior to the initial serious concerns meeting, the chairperson will determine how to involve and communicate with the provider. The provider may be invited to all or part of the meeting and following the meeting they will be informed in writing of the presenting issues and the actions to be taken.

What is the process?

The Initial Serious Concerns meeting will:

  • Share information and discuss concerns about a care provider
  • Be attended by all relevant agencies and include specialist input where required, for example, medicine management and nutrition support
  • Consider details of a specific case where the criteria for a Safeguarding Adults Review has been met
  • Share information from other meetings where concerns have been discussed, for example: Risk Summit Meetings, Assurance and Resilience Groups, Provider Review Groups, Contract and Commissioning Provider meetings
  • Identify any further concerns to be investigated
  • Agree the investigative framework
  • Clarify roles and responsibilities in any investigation
  • Ensure action is taken to minimise the risk to adults currently receiving a service
  • Identify and record named contacts for each agency
  • Develop a multi-agency action plan for improvement.

Where the concerns are about the quality of care and the safety of adults a number of actions may be taken including:

  • Police investigations should take priority
  • Assessing/reviewing individual cases
  • Interviewing adults and/or family/carers
  • Health investigations
  • Liaising with other professionals with access to the service
  • Liaising with other commissioning authorities
  • Contract compliance checks
  • Increased monitoring and oversight of the service
  • CQC inspection / regulatory action
  • Staff interviews 6 Suspension of new admissions to a care home:
  • If the issue relates to a Local Authority commissioned service, this will be a decision for the Local Authority in line with their individual contract / moratorium policy
  • A suspension can be voluntary or imposed
  • CQC, under their regulatory powers, are able to suspend new admissions to services, including when a commissioner cannot or chooses not to do so.

DSP Multi-Agency Safeguarding Adult Procedures applies to the management of individual safeguarding cases. If this process has been instigated prior to the completion of any ongoing safeguarding enquiries or investigations, then the initial serious concerns meeting must decide:

a)    If a separate process is required to consider any individual safeguarding cases

b)    How feedback will be communicated to the wider group. Care must be taken to ensure individual adults at risk are not overlooked during this process, and individual investigations should not be delayed whilst waiting for a serious concerns meeting to be convened.

Effective joint working is essential to ensure the process achieves its objectives. It will be important to clarify:

  • Communication with the service provider
  • Communication with adults at risk and their families/carers
  • Communication with funding authorities, such as Locality NSH Commissioners (former CCGs), CHC and other Local Authorities
  • Liaison between agencies and professionals
  • Contact with the media (subject to agreement)
  • Legal advice, as appropriate
  • Security of records
  • Maintenance of a central file of minutes of meetings/action plans/records of individual safeguarding cases.

The action/improvement plan must identify any practice or policy changes, or improvements required and the agency responsible for assessing any changes or improvements including timescales for completion. Any potential criminal offences or enforcement requirements must be recorded and referred on to the appropriate agency for consideration. Review meetings should be arranged at regular intervals to assess the extent of changes and improvements made according to the agreed action plan.

Lower level concerns, which do not meet the criteria for invoking this Procedure should be communicated to the relevant commissioner to ensure ongoing monitoring can take place and therefore prevent concerns from escalating any further.

Any additional concerns (both general concerns and concerns about specific individuals) that are raised during the process should form the basis of an immediate discussion amongst the key agencies and then a decision made about the action to be taken in consultation with the Chairperson.

The DSP Business Unit will be informed of the outcome of the initial and subsequent meetings and advised if this Procedure has been invoked. The Business Unit will maintain a record of those services and providers who have been subject to these procedures and the actions taken.

Review meetings will receive feedback from the investigations and other actions including progress against the action plan. The investigations and other actions may evidence serious care quality concerns, but the concerns may not be so serious as to determine that organisational abuse has taken place. However, in situations of exceptionally high risk, or if partner agencies fail to reach an agreement the relevant Directors/Assistant Directors and Elected Members must be informed.

An Outcome and Lessons Learned meeting will conclude the process and confirm that the action/improvement plan is complete and that the service is delivering care to a sustained, safe standard. The meeting will also consider any lessons learned from the process and the associated documentation will be completed as outlined above. Record Keeping Meetings should be managed and recorded in the following recommended format and standard documentation.

Record Keeping

Meetings should be managed and recorded in the following recommended format and standard documentation.

Initial meeting framework:

  • Meeting to convened as soon as practicable to review the serious concerns being raised (timing will be determined by the level of risk and evidence provided along with consideration of any dual investigations ongoing)
  • Purpose of Meeting
  • Details of safeguarding enquiries/outcome of safeguarding investigations
  • Details of multi-agency concerns
  • Information known about the service provider, including other services
  • Outcomes from CQC inspections
  • Outcomes from Contract Service Reviews
  • Multi-agency assessment of risk
  • Issues requiring investigation
  • Clarification of roles/responsibilities in investigation framework
  • Resources required to support investigation/s
  • Actions required to ensure ongoing safety of adults at risk
  • Consider suspension of new admissions and agree a timescale for review this decision
  • Identification of any individuals specifically at risk and whether individual safeguarding procedures apply
  • Agree timescales for further meetings
  • Decide how to communicate with and involve the service provider, organisation or adult/s at risk in future meetings
  • Agree a communication plan and responsibility for keeping people informed about the process
  • Ensure minutes of the meeting are written, agreed and shared with relevant parties within 14 days of the meeting
  • DSP to be informed of the outcome of the meeting.

Record of Multi-Agency Initial Meeting template (Appendix 1) [word document]

Review meeting framework:

  • Purpose of meeting
  • Details of any additional safeguarding concerns/multi-agency concerns
  • Reports on the outcome of any investigations/actions
  • Feedback from any individual safeguarding investigations/assessments
  • Reach a conclusion as to whether the stated outcomes of the process have been met
  • Review multi-agency assessment of risk
  • Review progress in relation to implementation of the multi-agency action plan/care provider improvement plan
  • Agree any further action required to ensure the ongoing safety of adults at risk
  • Agree any additional contract compliance arrangements
  • Agree timescales and attendees for future meetings, attendees must ensure they prioritise any future meetings
  • Maintain the communication plan and responsibility for keeping people informed about the process
  • Review the decision to impose a suspension on new placements
  • Ensure minutes of the meeting are written, agreed and shared with relevant parties within 7 days of the meeting.

Record of Multi-Agency Review Meeting template (Appendix 2) [word document]

Outcome and Lessons Learned meeting framework:

  • Purpose of meeting
  • Finalisation of action/improvement plan
  • Decide that it is appropriate to conclude the process e.g. clear and sustained improvement in the quality of care delivered
  • Confirmation of storage of records and agreement in relation to the information recorded on individual case files/electronic records
  • Identification of lessons learned for all involved and how changes will be implemented to reduce risks
  • Follow up recommendations
  • Follow up action plans (including timescales if applicable)
  • Multi-agency issues and considerations
  • Timescales

The completed Lesson Learned document will be forwarded to the DSP Business Unit. The information contained therein will be considered by the DSP Learning & Development Group.

Record of Multi-Agency Outcome and Lessons Learned Meeting template (Appendix 3) [word document]

(Last revised and approved August 2023)