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Procedure and Process

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]