Safeguarding Discussions and Meetings

1. Using this Procedure

This is a multi-agency procedure, meaning it applies to all organisations in Northumberland.

2. Overarching Aims, Duties and Principles

The overarching aims, duties and principles of safeguarding

All of the overarching aims, duties and principles of adult safeguarding apply.

These are:

• The aims of adult safeguarding;
• The duty to promote individual Wellbeing;
• The six key principles of all adult safeguarding;
• Making Safeguarding Personal; and
• The principles of the Mental Capacity Act.

See: Overarching Aims, Duties and Principles Procedure.

Other principles and duties that apply

Strengths based approach

Wherever possible, every conversation with the adult (or their representative) should be from a strengths perspective. This means that before you talk about external solutions to help achieve an outcome or manage a risk you must support the adult to explore whether there is:

1. Anything within their own power that they can do to help themselves; or
2. Anything within the power of their family, friends or community that they can use to help themselves.

A strengths based approach is empowering for the adult and gives them more control over their situation and how best to resolve any issues in the best way for them. The end result may still be that the local authority or another organisation intervenes, but this decision will have been reached knowing that it is the most proportionate response available.

Adopting a strengths based approach involves:

1. Taking a holistic view of the adult's needs, risks and situation in the context of their wider support network;
2. Helping the adult to understand their strengths and capabilities within the context of their situation;
3. Helping the adult to understand and explore the support available to them in the community;
4. Helping the adult to understand and explore the support available to them through other networks or services (e.g. health);
5. Exploring some of the less intrusive/intensive ways the local authority or other organisations may be able to help (such as through prevention services or signposting).

Good information and Advice and Prevention

The duty to provide good information and advice and to consider ways to prevent, reduce or delay needs for Care and Support applies at all times.

It is vital that you understand your duties in relation to the above. Please use the links below to access further information as required.

• Preventing Needs for Care and Support for information about the duty to prevent, reduce or delay needs;
• Providing Information and Advice for information about the duty to provide good information and advice, including the duty to make sure that information and advice is accessible to the person receiving it.

3. Involving the Adult in Safeguarding Discussions and Meetings

In line with the overarching aims and principles of all safeguarding, the adult should be encouraged to be involved in all safeguarding discussions and meetings, in whichever manner works best for them.

Outcomes

Put simply an outcome is anything that, as a consequence of the safeguarding process the adult:

1. Wants to achieve;
2. Wants to change; or
3. Wants to stay the same.

If not already expressed, outcomes must be sought before carrying out any enquiries.

This can be done by the lead practitioner or an independent advocate, whichever is deemed most appropriate and proportionate to the presenting circumstances.

See: The Skilled Conversation: Outcomes.

Declining to be involved

If the adult does not wish to be party to a discussion or meeting, their views and wishes in relation to desired outcomes and potential risk management strategies should still be sought and regarded.

If the adult expresses a clear view or wish about any aspect of the safeguarding process, decisions made should reflect this as closely as possible.

The adult should still be informed of any decisions made and supported to be a part of any subsequent discussions/meetings, if they wish to be.

Representation

The duty to appoint an independent advocate should have been established when the concern was raised.

Where the duty applies the appointed advocate must be a part of all safeguarding discussions and meetings to ensure the adult is effectively represented.

Where an advocate is not required because an appropriate other person has been identified to represent the person, that person must be invited to do so.

Good practice for involving the adult in safeguarding discussions and meetings

Adults that lack capacity

Even if the adult has been assessed as lacking capacity to make their own decisions within the safeguarding adult's process, it is still important that they are consulted.

The purpose of consulting and involving the adult is to understand, as far as is reasonably ascertainable:

1. What their views are on any matters affecting the decision;
2. What is important to them (the relevant factors); and
3. What their preferred outcomes may be.

Note: 'Reasonably ascertainable' means the information that can be gathered in the time that is available before the decision needs to be made. What is available in an emergency will be different to what is available in other situations.

You must not proceed to make any Best Interest decision without carefully considering the information gathered from the person during consultation.

For further guidance see the Mental Capacity Act 2005 Resource and Practice Toolkit: Preparing to make a Decision.

4. Initial Strategy Discussion/Meetings

What is an initial strategy discussion/meeting?

An initial strategy discussion is a professional conversation between the local authority and any or potentially all of the multi-agency safeguarding partners.

When to have an initial strategy discussion/meeting

An initial strategy discussion/meeting should take place on receipt of partner information and the adults or their advocates views.

After reviewing all available information, if the professionals involved feel there is reasonable cause to suspect abuse and neglect and that actions are needed to prevent or stop it, then a Section 42 Enquiry must be initiated.

Involvement of the adult

See Section 3, Involving the Adult in Safeguarding Discussions and Meetings.

The initial strategy discussion/meeting

Actions to complete

1. Agree an initial safety plan identifying risks;
2. Establish if the adult requires a formal advocate where appropriate;
3. Consider Mental Capacity Act where appropriate;
4. Record decision and rationale.

If the police are already investigating

It is important to establish that any action the local authority plans to take will not obstruct or impede any ongoing police investigation.

As such, the police involved with the Multi-Agency Safeguarding Hub (MASH) will be consulted during the MASH process.

If the investigating officer/MASH police representatives requests the local authority withhold from carrying out some/all of the actions proposed it must not carry these out until they advise otherwise. If the investigating officer requests the support of the local authority in carrying out any alternative actions, co-operation should be provided. The Care Act is clear that any criminal investigation into the alleged abuse or neglect takes precedence.

Note: Although the allocated Chair may have to put investigative enquiry actions on hold, any resilience and recovery actions to support the adult to deal with what has happened and reduce future risk should still take place.

Risk to others

Any potential or actual risk to others should be identified, and appropriate safeguarding actions in respect of those person/s should be taken.

For example:

1. Is the abuse or neglect taking place in a setting where other adults may be (e.g. a day service or care home)?
2. Does the person alleged to be causing harm work with other adults (in the same setting or other settings)?
3. Where abuse or neglect is taking place in the adult's home, are there any children living there?

Depending on the circumstances, the following are some examples of some actions that may be deemed appropriate:

1. Additional monitoring of an adult at risk (or other adult with care and support needs alleged to have caused harm);
2. Additional supervision of a staff member;
3. Temporary changes to the routine of an adult at risk (or other adult with care and support needs alleged to have caused harm);
4. Temporary relocation of the adult (or other adult with care and support needs  alleged to have caused harm;
5. Suspension without prejudice of a staff member;
6. Raising a concern to children's services.

How to report concerns about a child

As Northumberland County Council operates a joint Children and Adult's MASH, any concerns about children will be shared with the MASH representatives.

If you are concerned that a child is in imminent danger from abuse or neglect, or that a criminal act has taken place you should contact the police by dialing 999.

Recording the initial strategy discussion/meeting

Discussions should be clearly recorded in line with local recording requirements.

Records should be clear about the rationale behind decisions made, actions agreed and how the views and wishes of the adult have been regarded.

5. Further Strategy Meetings

The purpose of a further strategy meeting

Put simply, a further strategy meeting is an opportunity for relevant professionals and agencies involved with the adult to:

1. Share information relevant to the enquiry;
2. Agree the level of risk to the adult and others;
3. Agree what enquiries need to be made;
4. Agree which actions are required in order to reduce, remove or manage risk.

Timeframes for the initial further strategy meeting

The initial further strategy meeting must be scheduled no more than 10 working days after the initial strategy discussion/meeting.

Depending on the presenting circumstances, this may or may not take the form of a physical meeting.

Organising a further strategy meeting/s

The allocated Chair is responsible for organising the further strategy meeting.

1. When to hold the meeting;
2. How to hold the meeting (i.e. face-to-face, virtually, telephone calls);
3. Who to invite to the meeting (see below); and
4. Gathering or requesting information for the meeting.

Involvement of the adult in meetings

See Section 3, Involving the Adult in Safeguarding Discussions and Meetings.

Involvement of others

The professionals and agencies invited to be part of the meeting should be determined by the nature of the safeguarding concern and their involvement with the adult.

Depending on the circumstances, the following are examples of those who could be invited:

• Representative from health (ICB/ NHS Trust);
• GP;
• Police;
• Representative from education;
• Psychologist;
• Psychiatrist;
• District nurse;
• SALT team;
• Social worker;
• Care home managers;
• Representative from care provider;
• Care Quality Commission;
• Department of Work and Pensions (DWP);
• Housing officers.

A minute taker should also be invited.

Police

The police should always be invited when either a criminal act may have occurred, or when they are already investigating.

It is important that any action the local authority plans to take will not obstruct or impede any ongoing police investigation. As such, if the police are unable to attend the strategy meeting the allocated Chair must establish from the investigating officer any potential enquiry actions that may/may not be carried out. The Care Act is clear that any criminal investigation into the alleged abuse or neglect takes precedence.

Note: Although the allocated Chair may have to put investigative enquiry actions on hold, any resilience and recovery actions to support the adult to deal with what has happened and reduce future risk should still take place.

If services are funded through NHS Continuing Healthcare (or jointly)

A representative from the ICB should be invited when services are funded wholly or partly by health.

If concerns are about a service provider

Where a service provider is (or may be) implicated in the abuse or neglect, the regulatory body (Care Quality Commission) should be invited.

The allocated Chair will discuss the appropriateness of the service provider themselves being invited with the Commissioning Manager. A decision may be made to exclude them or to invite a representative from their Head Office instead.

Where a decision is made to exclude the service provider, they must still provide any relevant information requested of them to support the meeting and subsequent enquiry.

Note: If the police are already investigating the service provider, advice should be sought from the police as to what can be discussed.

Health and Safety related concerns

If the concerns relate to harm caused to an adult because of a potential breach of the Health and Safety at Work Act 1974 (unsafe equipment or systems of work), the Health and Safety Executive (HSE) should be invited. Where the breach has occurred in a regulated service, the Care Quality Commission should also be invited.

Requests from the adult to involve others

If the adult requests that a particular person is involved in the meeting, for example a family member or friend that person should be involved (see below for guidance if that person is the person alleged to have caused harm). This will promote the aims of principles of safeguarding, and ensure a strength based approach.

The person alleged to have caused harm

The person alleged to have caused harm can only be invited if the adult has expressly requested it and the allocated Chair agrees.

The rationale behind a decision of this nature should be clearly recorded in line with local recording requirements.

Appropriate safeguards should be put in place to ensure any subsequent safeguarding plan is not jeopardised by the involvement of the person.

Where appropriate safeguards cannot be identified the person should not be invited.

Note: If the police are already investigating the person, they should be excluded from all discussions and meetings.

Chairing a further strategy meeting

Meetings should be chaired by the local authority.

The further strategy meeting discussion

The precise agenda should be determined by the nature of the safeguarding concern and the level of risk posed to the adult.

In all cases the following must be discussed:

For guidance on all of the following, see: Making Enquiries Procedure.

1. Different approaches to enquiry;
2. Deciding what enquiries need to be made;
3. Deciding who should make enquiries.

Interim Safeguarding Plans

The interim safety plan will have been established at the initial strategy discussion/meeting.

During the initial further strategy meeting (and at any subsequent strategy meetings) the safety plan should be reviewed to ensure its effectiveness.

For guidance on reviewing a safeguarding plan, see: The Safeguarding Plan Procedure.

Recording further strategy meetings

The discussion and outcomes should be clearly recorded in line with local recording requirements.

The record should be clear about the rationale behind decisions made, actions agreed and how the views and wishes of the adult have been regarded.

Storage of external documents

Any external documents provided at a planning meeting must be stored in line with Data Protection legislation and local recording policy. They should also be stored in a logical manner so they can be easily accessed should the information be requested by legal services or the police.

6. If the Adult Dies before an Enquiry

If an adult dies before an enquiry begins, it should not commence. As a matter of law an enquiry cannot be undertaken in relation to a person who is deceased.

Instead, an 'Information Sharing Meeting' should be held.

The information sharing meeting should consider whether a referral to the Safeguarding Adults Review Committee (SARC) is required, and whether any other action is needed.

1. Notification to the police;
2. Raising a concern (s) for others at risk;
3. Notification to the Care Quality Commission (CQC);
4. Notification to the appropriate Commissioning Team; and
5. Notification to the Coroner.

Note: Care should be taken by the Safeguarding Manager/Chair to avoid an information sharing meeting encroaching into a Section 44 SAR and therefore the remit of the SARC.

Referral for a Section 44 Safeguarding Adults Review

If the criteria for a Section 44 Safeguarding Adults Review is met, a Safeguarding Adults Referral must be made.

See: Safeguarding Adults Reviews (SARS).

It is important to remember that a Section 44 Safeguarding Adults Review relates to how safeguarding partners have worked together to safeguard the adult and is not appropriate for single agency issues / failure.

Notification to the police

The police should be notified as a matter of priority if:

1. The death of the adult is suspected to have been potentially attributed to abuse or neglect; and/or
2. There is reason to suspect that a crime is likely to be committed i.e. other people are at risk.

Raising a concern(s) for others at risk

If the circumstances of the death mean that there are reasons to be concerned about risks to other adults, enquiries may need to be made to decide whether action needs to be taken to protect them. For example this will often be necessary following a death in an organisational setting where other adults are continuing to receive a service.

If this is the case, follow the guidance in the Disclosure and Raising a Concern Procedure, Raising a Concern.

Notification to the CQC

If there are concerns about how a provider has cared for the adult prior to their death a notification should be made to CQC via the CQC website.

The CQC has powers to bring a criminal prosecution against health and social care providers for failing to provide care and treatment in a safe way.

Notification to the appropriate Commissioning Team

If there are concerns about the quality of care delivered by the provider, the relevant Commissioning Team (Local Authority and / or Integrated Care Board) should be notified. The Commissioning Team can instigate the provider concern process and, if necessary, decommission the provider if appropriate improvements are not made.

Notification to the Coroner

Following a death, it is usually a doctor, or the police, who will decide whether a referral to the Coroner is required. When a death has been referred to the Coroner, the Coroner will make decisions regarding whether a police investigation should take place and whether a post-mortem is required.

7. Reviewing Enquiries

At some point, all necessary enquiries will have been made and appropriate arrangements should be made to review the findings.

This should take place in a manner that is appropriate and proportionate to the presenting circumstances and nature of the enquiries undertaken.

Involvement of the adult

See Section 3, Involving the Adult in Safeguarding Discussions and Meetings.

Involving others

The professionals and agencies involved in any previous meeting/s relating to the enquiry should be involved in reviewing the findings, unless there has been a change in circumstances and their involvement is no longer relevant.

Reviewing the enquiries

Have enquiry objectives been met?

The objectives of a statutory enquiry under s42 of the Care Act are to:

1. Establish facts (determine what has actually happened/may happen);
2. Ascertain the adult's views and wishes;
3. Assess the needs of the adult for protection, support and redress and how they might be met;
4. Protect from the abuse and neglect, in accordance with the wishes of the adult;
5. Make decisions as to what follow-up action should be taken with regard to the person or organisation responsible for the abuse or neglect; and
6. Enable the adult to achieve resolution and recovery.

Based on the available evidence the meeting should seek to establish whether the objectives of the enquiry have been met. Where objectives have not been met, the meeting must decide:

1. Whether any further action is required; and
2. If so, by whom.

Examples of further action required could be to provide specific information or advice, to make a referral to a support service or to develop a Safeguarding Plan.

What is the risk outcome?

There are 3 potential risk outcomes and the meeting must agree which has been met by the intervention.

Next Steps

Developing a Safeguarding Plan

If risk remains (even if it has been reduced) then the need to develop a Safeguarding Plan (or maintain a Safeguarding Plan developed earlier in the process) must be considered.

A safeguarding plan will usually be required where the risk of abuse or neglect is:

1. Ongoing, complex, or unstable;
2. The risk of harm to the adult or others remains significant;
3. Other factors such as coercion, undue influence, or duress add to the complexity and uncertainty of the risk, and that the risk cannot be managed appropriately or adequately by other processes.

See: The Safeguarding Plan Procedure.

Closing the case

When enquiries reach their conclusion and the outcome is agreed the case should be closed to safeguarding.

If a Safeguarding Plan is to be developed (or is already in place), the overall case should still be closed but the Chair should maintain their involvement to ensure appropriate monitoring and review.

See: Closing a Safeguarding Case Procedure.

Identifying necessary actions to help prevent abuse or neglect in the future

Any additional actions that could prevent or reduce the risk of abuse or neglect occurring in the future should be identified and agreed.

This could include:

1. Information and advice about how to seek early help;
2. Ongoing advocacy;
3. Support to access a local support group;
4. Monitoring of a health risk by a medical professional;
5. Supporting a service provider to develop effective procedures e.g. whistleblowing, spotting signs of abuse;
6. Providing training to paid or unpaid carers around specific needs of the adult;
7. Support to develop communication skills;
8. A period of monitoring by the local authority, regulator or partner agency to make service provider issues are addressed;
9. Increased opportunities for decision making;
10. Specialist or further assessment.

Recovery and resilience

Adults who have experienced abuse and neglect may need support to recover and build up their resilience.

Any need for counselling should be identified. Where this would be beneficial the Chair should take steps to ensure that it is provided.

Resilience is the means by which an adult can learn from the experience and develop skills and knowledge that may prevent a reoccurrence.

As a minimum it should enable adults to recognise the signs and risks of abuse and neglect and know how to contact support if required.

The responsibility to notify other agencies

The table below sets out the different agencies that must be notified when abuse or neglect has occurred.

It is the responsibility of the Chair to monitor that referrals/notifications have been made by relevant partner agencies.

Recording the discussion

The discussion and outcomes should be clearly recorded in line with local recording requirements.

The record should be clear about the rationale behind decisions made, actions agreed and how the views and wishes of the adult have been regarded.

8. Professional Disagreements

All professionals and agencies involved in the safeguarding adults process have a responsibility to analyse the available information and to 'problem-solve' from their unique perspective. This approach ensures that decisions throughout the process are made based upon a full spectrum of expertise.

It is to be expected that, from time to time there will be disagreements between parties about what may constitute the best course of action, decision or plan.

Whenever a professional or agency has a concern a respectful challenge should be made, and the other party should be open to review.

The parties involved should attempt to resolve differences through discussion.

Ultimately, the local authority is the decision-maker in regards to the safeguarding process. As such, where disagreement persists the Safeguarding Manager should make any final decisions, having considered objectively all of the evidence and viewpoints presented.

If a party remains dissatisfied they can discuss their concerns with the Safeguarding Manager or make a formal complaint.

For further guidance, see: Process Maps and Case Studies, Dispute Resolution Process.