Safeguarding adults at risk procedure

Date: November 2021

Review date: November 2023

Version 4.0

Recognising an adult safeguarding concern

Responsibilities of all employees and volunteers

All trust staff must be able to

Recognise
Report
Record
And Raise / refer a concern to the local authority

If any member of staff or volunteer has reason to believe that abuse is or may be taking place, they have a responsibility to act on this information. Doing nothing is not an option.

If an adult discloses any experience of abuse or neglect, staff should:

Assure the person their concerns are taken seriously
Listen carefully to what the person is saying. Stay calm. Get as clear a picture as possible.
Explain duty for staff to pass this information on to their supervisor/manager and/or Adult Safeguarding Lead
Reassure the person they will be involved in all decisions made about them

Staff should not

Be judgmental or jump to any conclusions
Start to investigate or ask detailed or probing questions

Staff’s responsibilities are to:

Act to keep the person safe if possible

If urgent police presence is needed to keep someone safe, call 999

If the person needs urgent medical assistance, call 999

Inform their line manager and consult with their Directorate safeguarding lead or The Trust’s Adult Safeguarding Lead
Clearly record what they have witnessed or been told, and any responses or actions taken
If a crime has occurred, be mindful of the need to not to disturb evidence and the need to provide evidence

If consulting with the Safeguarding Adults Lead will lead to an undue delay and thereby leave a person in a position of risk, referral should be made to the relevant local authority.

Historic abuse

Abuse that took place when a person was under 18 years old is not an Adult Safeguarding issue but dependant on the concern, could be a child safeguarding issue, irrespective of how old that person is now.

In certain cases, the relevant Children’s Social Care department may need to be informed, if for example, the person who caused harm, is considered as a continued risk to other children. Adults who disclose historical childhood abuse can be advised that this is a crime and that they can still report this to the Police, if they want to do this

Reporting within the Trust

The clinician responsible for the case must inform the Service Manager of all safeguarding concerns. In all cases the clinician should seek advice and discuss their concern(s) with the Safeguarding Adults Lead or Medical Director.

Recording adult safeguarding work

Safeguarding concerns should be fully documented by the first person to report the suspected abuse, and at all subsequent stages by those involved with the adult.

Concerns are recorded using the adult safeguarding form on CareNotes (see Appendix C). Forms should be completed as soon as possible after a concern (an appearance of abuse/neglect) is identified, whether it becomes substantiated or not.

The responsible clinician will monitor and record the ongoing care and wellbeing of the patient during any adult safeguarding enquiry. Safeguarding supervision during the assessment or treatment of a patient or service user, must also be recorded (see appendix C).

The outcome of the safeguarding enquiry should be clearly documented in the patient record.

Referring raising a concern with the Local Authority

Deciding whether a referral to the local authority is required

In all cases where it’s suspected that an adult in need of care and support might be experiencing or at risk of experiencing abuse or neglect, this should be reported to the relevant local authority and the police (where it is believed or suspected that a crime has been committed – see also information sharing below).

It should never be assumed that someone else will pass on this information. If you think another staff member or another organisation may have made a referral please check.

Where the person who may be at risk is not well known to the trust and it is not clear whether they have care and support needs, the appropriate local authority should still be alerted as they may have other relevant information and it is for the local authority rather than the trust to determine whether a person is eligible for safeguarding support. However where possible include any information held about possible care and support needs as this will make the local authority decision easier and quicker and reduce delays.

Referring an adult safeguarding concern to the local authority

This is also known as ‘raising a safeguarding concern’. Anyone can raise a safeguarding concern.

The concern should be reported to the local authority where the abuse or neglect is taking place or is at risk of doing so (see appendix A).

A safeguarding enquiry is the responsibility of the local authority.

A concern should be raised with the local authority if there is any reason to think a person

has needs for care and support (whether or not these are currently being met) and
are experiencing, or are at risk of, abuse or neglect, and
because of those needs are unable to protect themselves against the abuse or neglect or the risk of it.

Staff need to establish:

The current level of risk and what immediate steps are needed to ensure safety
The individual’s wishes and views about the safeguarding concern including their views regarding sharing information with other agencies including the local authority or the police
Wherever possible, safeguarding concerns should be raised with the consent of the patient (however consent may not be required to raise a safeguarding concern)
Where there are issues of mental capacity, whether the patient has capacity to make specific decisions regarding their own protection and to understand the safeguarding

In the event that people lack the capacity to provide necessary consent, action should be taken in line with The Mental Capacity Act 2005 (see appendix B). Staff should refer to the Trust’s MCA guidance.

Where a referral has been made to the local authority or another agency, the responsible clinician should follow this up to ensure that this has been acted upon.

Sharing information

The priority in safeguarding is to ensure the safety and well-being of the adult. However, there may be some occasions when the adult at risk does not want to pursue a referral to the Local Authority.

If the adult’s consent is refused, we should only proceed to share information if:

The concern is so serious that sharing would meet the significant public interest threshold
The person is unable to give valid consent due to lacking mental capacity to do so
Other people would be at risk if information were not shared.
The situation is so urgent that it is not possible to obtain the person’s consent

If the decision is to act without the adult’s consent, then unless it is unsafe to do so, the adult should be informed that this is being done and of the reasons why; for example, where you believe there is a threat to someone’s life and you believe the person is unable to protect themselves because of their physical or mental health vulnerabilities.

Where such decisions have been taken, staff should keep a careful record of the decision-making process.

There are only a limited number of circumstances where it would be acceptable to not share information pertinent to safeguarding with the local authority. These would be where the person involved has the mental capacity to make the decision about sharing information, does not want their information shared and:

nobody else is at risk
no serious crime has been or may be committed
the alleged abuser has no care and support needs
no staff are implicated
no coercion or duress is suspected
the public interest served by disclosure does not outweigh the public interest served by protecting confidentiality
the risk is not high enough to warrant a Multi-Agency Risk Assessment Conference referral (MARAC)[1]
there is no legal duty to share the information

Further information can be found in the Social Care Institute for Excellence Adult Safeguarding: Sharing information guide

Staff should be vigilant of possible coercion and the emotional or psychological impact that the abuse may have had on the adult and should

Explore the reasons for the adult’s objections (what are they worried about?)
Explain the concern and why it might be important to share the information
Tell the adult with whom information might be shared and why
Discuss the benefits, to them or others, of sharing information (access to better help and support?)
Discuss the consequences of not sharing the information (could someone come to harm?)
Reassure them that the information will not be shared with anyone who does not need to know
Reassure them they are not alone, and support is available to them

If, after this, the adult requests that information about them is not shared with the local authority or if there is a clinical reason that their information should not be shared with the local authority, this should be discussed with the Adult Safeguarding Lead and/or the Medical Director. / Caldicott guardian.

Decision Not to Share Information

Where, following discussion with the Adult Safeguarding Lead and/or the Medical Director / Caldicott guardian, the decision is not to share safeguarding information with the local authority or other safeguarding partners, the clinician responsible should

Support the adult to weigh up the risks and benefits of different options
Ensure they are aware of the level of risk and possible outcomes
Offer support for them to build confidence and self-esteem if necessary
Agree on and record the level of risk the adult is taking
Record the reasons for not intervening or sharing information
Regularly review the situation
Try to build trust to enable the adult to better protect themselves.

It’s important that the risk of sharing information is also considered. In some cases, such as domestic abuse or hate crime, it’s possible that sharing information could increase the risk to the adult. Safeguarding partners need to work jointly to provide advice, support and protection to the adult to minimise the possibility of worsening the relationship or triggering retribution from the abuser.

Local authority triage S42 enquiries

The local authority receiving the referral will triage the referral and decide if the grounds set out in section 42 of the Care Act are met. These are that the person:

has needs for care and support (whether or not these are currently being met) and
is experiencing, or at risk of experiencing, abuse or neglect, and
because of those needs is unable to protect themselves against the abuse or neglect or the risk of it.

If these conditions are met, then there must be an adult safeguarding enquiry. The local authority will determine what actions are required, by whom, and when they need to happen.

Principles of Making Safeguarding Personal will apply and the local authority should engage the person in a conversation about how best to respond to their situation in a way that enhances their involvement, choice and control, and clarify what outcomes they would like to see happen.

What is an ‘adult safeguarding enquiry’?

Where a local authority believes an adult at risk is experiencing or at risk of experiencing abuse or neglect, it must make enquiries), or cause others to do so. This is a duty under S42 of The Care Act 2014.

An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect, and if so, by whom.

The objectives of an adult safeguarding enquiry are to:

establish facts
Ascertain the adult’s views and wishes
Assess and address their need for protection and support, in accordance with the wishes of the adult
make decisions as to what follow-up action should be taken
enable the adult to achieve resolution and recovery

A section 42 enquiry will not necessarily lead to a full investigation – this will be decided by the local authority. In making this decision, the Local Authority will consult with the adult at risk about their wishes and may gain views of other relevant professionals (including involved clinicians).

In the event of an adult safeguarding enquiry, the local authority will ensure that where necessary, a protection or enquiry plan is put in place. An Enquiry Plan is usually drawn up and actions assigned to those ‘best placed’ to support with the Enquiry process.

Often a professionals meeting takes place (this could be a series of conversations) so that information can be effectively shared, and actions agreed in order to safeguard the adult at risk.

Enquiry closure

S42 Enquiries are closed when:

There is a plan in place to safeguard the adult and risks have been removed or reduced
The adult requests that the process is halted and there are no overriding reasons not to comply with their request.
The risks remain but all possible interventions and actions have been exhausted

Abuse occurring within the Trust

Where it is alleged that the abuse relates to care in the trust, the trust’s Managing Allegations against Staff procedure should also be followed.

Supporting staff

The Trust recognises that involvement in any aspect of identification or reporting of suspected abuse of an adult at risk can be a difficult experience and it is committed to supporting staff through the process of raising a safeguarding concern. Service managers, the Adult Safeguarding Lead and/or the Medical Director should offer feedback and support to the member of staff where appropriate.

Staff are advised at Induction that the Trust provides a Staff Advisory Service which can be accessed by any member of staff, where a trained professional will offer one-to-one support.

Safeguarding supervision

Staff who have cases where there are adult safeguarding concerns should receive specific safeguarding supervision from either their Line or Team Manager, or a directorate staff member with designated safeguarding supervision responsibilities or the trust adult safeguarding lead.

Safeguarding supervision can be provided either on a one to one basis or via team-based discussion. Safeguarding supervision needs to be recorded onto patient notes using the relevant CareNotes over-18 adult safeguarding supervision form.

Contacts

Adult Safeguarding & PREVENT Lead can be contacted via

Safeguarding@Tavi-Port.nhs.uk

References

Other resources

Appendix A Raising a safeguarding concern with the Local Authority

How do I know which Local Authority to raise a Safeguarding Concern with?

Concerns about adult abuse should be raised with local authority where the adult is experiencing or is at risk of experience abuse/neglect (whether or not the adult is ordinarily resident there).

Clinicians need to identify in which local authority the possible abuse/neglect is occurring and to contact the relevant Adult Social Care Department or Safeguarding Adult Service to raise the concern. If in doubt, ask the adult to which Authority they pay their Council Tax

Where the concern has occurred on Trust premises or within Camden, staff should raise the adult safeguarding concern using the below contact details:

Contact Camden Adult Social Care

Telephone: 020 7974 4000 (select option 1)

Email: adultsocialcare@camden.gov.uk

Online: Safeguarding Referral Form

Website: Referral options and adult safeguarding information