Safeguarding Adults Procedures

Where there is any abuse or suspicion of abuse that relates to a relevant adult at risk, the concern must be reported to the relevant Multi-Agency Safeguarding Hub (MASH) by using the online referral form (for Cambridgeshire), telephone or secure email using the adult safeguarding referral form which can be found at: Concerned? | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

Customer Service Contact Details for Safeguarding Referrals for Adults At Risk:

Referral to the Multi-Agency Safeguarding Hub via the Council’s Customer Services must be made on the same day using the Adult Safeguarding Referral form (Online for Cambridgeshire). Please note agencies should not submit referrals on any other form. Reporting should not be delayed by the need to complete the form.

Cambridgeshire County Council: Practitioner reporting of concerns about an Adult at Risk – Cambridgeshire county Council

If you are unable to use the online referral form for Adults At Risk, please complete the old paper referral form and email to referral.centre-adults@cambridgeshire.gov.uk

Peterborough City Council: please complete the old paper referral form and email to adultsocialcare@peterborough.gov.uk

There may be occasions when your designated safeguarding lead is unsure whether to report or not e.g. the adult has refused consent to share the information or the vulnerability of the adult is uncertain. If in any doubt, the designated person / manager must consult the MASH via the Council’s Customer Services for advice

Details of how to make a ‘Good Safeguarding Referral’ can be found in Appendix Three.

7.3 If you have concerns about the safety of a Child or Young Person under the age of 18

If a child is in immediate danger, please call the police and/ or ambulance on 999

If there are concerns that a child is at risk of significant harm, then an immediate report must be made to the Children’s Multi-Agency Safeguarding Hub. All telephone referrals will need to be followed up in writing within 24 hours by the referring professional.

Professionals should use the online referral form to submit safeguarding concerns to Children’s Services. This is a much more secure and efficient way of submitting a referral and will also give you a reference number on submission. The online form should be used instead of Word or PDF versions of the form.

Cambridgeshire County Council: Professional reporting of child abuse – Cambridgeshire County Council

Peterborough City Council: Professional reporting of child abuse – Peterborough City Council

If there are concerns about a child but they are not at significant risk of harm, the Early Help team should be contacted.

7.4 Concerns about Reporting Abuse to your Designated Contact Person / Line Manager

If you believe the designated contact person / line manager to be implicated in the abuse, or you as a worker do not feel able to discuss it with him / her then you must approach another or more senior Manager, or use your organisation’s Whistle Blowing procedure, or contact the Multi-Agency Safeguarding Hub via the Customer Services.

7.5 Allegations Against a Member of Staff

In all cases where an adult at risk is deemed as being at a safeguarding risk from a member of staff then the safeguarding referral process should be followed as above.

Additionally, your own agency will have standard policies and procedures in relation to whistleblowing and reporting allegations against members of staff.

7.6 People In Positions of Trust

The Cambridgeshire and Peterborough Safeguarding Adults Partnership Board has in place a framework and process for the management of allegations against “People In a Position of Trust” (PiPoT)

The meaning of the term people in a position of trust is “people who work, in either a paid or unpaid capacity, with adults with care and support needs”.

In relation to this process the person in a position of trust will have had an allegation raised that they may pose a risk to adults at risk because, in their life outside of their work environment, they are alleged to have:

• behaved in a way that has harmed, or may have harmed an adult or child
• possibly committed a criminal offence against, or related to, an adult or child
• behaved towards an adult or child in a way that indicates they may pose a risk of harm to adults with care and support needs”

The procedure for making a referral to the Multi-Agency Safeguarding Hub in relation to a PiPoT can be found at the link below: Procedure for Managing Allegations against People in Positions of Trust (PiPoT) | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

7.7 Making a Safeguarding Referral for a Multi-Agency Risk Assessment Management (MARM)

For very specific cases, where an adult at risk has mental capacity but continues to place themselves at risk and is not engaging with services, you should refer to the Multi-Agency Risk Assessment Management (MARM) Guidance.

The guidance must only to be used where the adult at risk:

• has the mental capacity to understand the risks posed to them
• continues to place themselves at risk of serious harm or death
• refuses or is unable to engage with necessary care and support services

For the guidance on the MARM please see: Multi-Agency Risk Management Guidance | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

7.8 Multi-Disciplinary Team Meetings

When working with a complex case involving the safeguarding of an adult at risk it may be necessary for agencies to come together to discuss the case and formulate a plan of action and support (i.e. Strategy Meeting). Peterborough City Council and Cambridgeshire County Council have prepared a fact sheet to support the implementation of Multi-Disciplinary Meetings and more details can be found in Appendix Four.

7.9 Preservation of Evidence

The over-riding aim of these Multi-Agency Adult Safeguarding Procedures is to protect people with care and support needs who are at risk from abuse, maltreatment and neglect.

The preservation of evidence where a crime may have been committed contributes to this goal, but the immediate protection of adult at risk is the highest priority. However, care must be taken to ensure that forensic and other evidence is not contaminated.

Action to ensure the preservation of evidence must not be to the detriment of any immediate medical care or the protection of any person with care and support needs. Advice from the police must be obtained before conducting any enquiries into matters which may become subject to a criminal enquiry. Where there is potential for this situation occurring, you can avoid contaminating evidence or compromising enquiries by:

• Not interviewing the adult at risk, alleged perpetrator or potential witnesses after a disclosure has been made. This is the responsibility of the police or the person/agencies agreed by the adult at risk planning meeting. General support for the wellbeing of the adult at risk should continue.
• Note that safeguarding staff need to ask the immediate questions necessary to protect a person with care and support needs but to avoid jeopardising a criminal enquiry.
• Disturbing a ‘scene’ as little as possible, sealing off areas if possible and locking rooms to restrict further access – keep a note of what rooms you have accessed
• Discouraging washing/bathing where possible in cases of sexual assault
• Not handling items which may hold DNA evidence
• In emergencies ensuring that the police are involved as quickly as possible calling 999

7.10 Securing records

Where necessary, and to avoid tampering, relevant files and documents must be secured by removing them to a secure place or locking them away, or restricting access if electronic files, in order to preserve their integrity. Any attempt to alter files, electronic or paper, in response to a safeguarding allegation may constitute a criminal offence.

7.11 Recording Safeguarding Concerns & Safeguarding Disclosures

Concerns about safeguarding abuse against an adult at risk must be recorded as soon as possible and always on the same day

Good record keeping is a vital component of professional practice and is essential from the first contact with an adult at risk to case closure. Record keeping is central to the processes of risk assessment, safeguarding

Whenever a concern or allegation of abuse is made, agencies must keep clear and accurate records and each agency should identify procedures for incorporating, on receipt of a complaint or allegation, all relevant records into a file to record all action taken.

When abuse or neglect is raised managers need to look for past incidents, concerns, risks and patterns. We know that in many situations, abuse and neglect arise from a range of incidents over a period of time. In the case of providers registered with CQC, records of these should be available to service commissioners and the CQC so they can take the necessary action.

Records must provide accurate, factual, verifiable information and specify where they are based on direct observation

See appendix for details on how to keep records and how to make them secure Appendix Five.

8. What Happens Once the Safeguarding Referral is Received at the Multi-Agency Safeguarding Hub?

The person in the Multi-Agency Safeguarding Hub receiving the safeguarding concern will:

• Where it is identified by the Multi-Agency Safeguarding Hub Safeguarding Team that urgent action is needed to protect the safety of one or more adults and this has not already been taken, they will take immediate action to commence enquiries and protect any person with care and support needs from the identified harm. This will happen on the same day that the concern is received. The action will be recorded by the Multi-Agency Safeguarding Hub.
• Acknowledge receipt of the safeguarding concern.
• At all times, a professional approach should be adopted when anonymous referrals are made in relation to whistleblowing policies and reassurance of anonymity is provided. However, anonymity is generally discouraged and the person raising the concern should be supported to enable them to divulge their identity whenever possible. The safeguarding referrer should be asked whether their safety is or will be compromised, should the person alleged to be causing harm know the source of the safeguarding concern.
• Record the safeguarding concern – All safeguarding concerns must be recorded within 24 hours of contact.
• When the concerns relate to an adult at risk who lives or receives services in another local authority area, both local authority social services departments must be informed by the service provider manager / designated person. The funding authority will have a vested interest and will need to be involved.
• If a referral is made anonymously, every effort should be made to encourage the person to give contact details. It can be confirmed that their identity can be withheld and explained that the enquiry will be more difficult without this. However, if they persist in remaining anonymous the referral should be taken, nevertheless.

9. Adult Multi-Agency Safeguarding Hub (MASH)

9.1 Adult Multi-Agency Safeguarding Hub’s responsibilities

The Local Authority has statutory duties under the Care Act 2014 to develop procedures for identifying the circumstances giving grounds for a safeguarding concern. Local authority Teams based in the Multi-Agency Safeguarding Hub have responsibility for assessing the potential seriousness of a safeguarding concern, appropriate liaison with other relevant agencies and for determining what response is required.

The key adult safeguarding responsibilities of the Multi-Agency Safeguarding Hub are:

• Triage of adult at risk safeguarding referrals
• Ensuring that the adult at risk is involved and consulted throughout the process
• Screening-out inappropriate referrals and signpost where appropriate
• Ensuring appropriate immediate action is taken
• Identify the key team or organisation that will carry out the enquiry under S.42 of the Care Act 2014
• Collate and share any relevant information with the key team or organisation undertaking the S.42 enquiry
• Provide advice and support to care teams on safeguarding issues
• Oversee the collection of management information
• The Multi-Agency Safeguarding Hub can also ask the provider for a report – the following link takes you to the provider factsheet and report template, which may be helpful in these circumstances: Safeguarding Adults – Provider Section 42 Enquiry | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

These responsibilities may require discussions between other agencies

Other responsibilities include ensuring:

• That every safeguarding concern referred receives a clear response.
• The person alleged to have been harmed and other people with care and support needs participate in the decision-making process and are protected from abuse and harm occurring or reoccurring.
• That the level of response is proportionate to the perceived level of risk and seriousness and reflects the desired outcomes stated by the adult at risk. The Human Rights Act 1998 requires public authorities to intervene in people’s lives in a way that is proportionate to the presenting concern should not be arbitrary or unfair. Intervention must have a basis in law and must secure a legitimate aim to prevent abuse or crime. The seriousness or extent of abuse is often not clear when a safeguarding concern is first expressed. The interventions must be proportionate to the nature, degree and intensity of the concern and the risk presented. This may result in a decision to take no further action based on the evidence available
• That interventions centre on the person alleged to have been harmed and other people with care and support needs to maintain choice and control for themselves.
• The involvement of an appropriate relative, friend, advocate or court appointed deputy when a person alleged to have been harmed lacks the mental capacity to participate in the Safeguarding process, will be required.

9.2 Determining the relevant Local Authority

Responsibility for leading an enquiry lies with the area where the alleged abuse took place.

Some adults at risk living in our areas (Peterborough and Cambridgeshire) are the responsibility of other local authorities. For the purposes of this section the area in which they are living is the “host authority” and the area with funding responsibility is the “placing authority”. For further guidance see Appendix Six.

10. Adult Multi-Agency Safeguarding Hub (MASH) Triage & Risk Assessment

10.1 Initial Response from MASH to the Safeguarding Referral

Once immediate safety measures are in place and the safeguarding concern has been raised, a decision about how to respond will be made by the Multi-Agency Safeguarding Hub team. This decision will reflect the desired outcomes of the adult at risk and will take one of three routes:

• No further action for the local authority (NFA) – Information and advice provided
• A formal safeguarding enquiry under section 42 of the Care Act 2014.

An investigation by the employer, using the local authorities’ power under section 42 of the Care Act 2014 to cause an enquiry. This will utilise internal investigation processes, such as, an incident investigation, serious incident, internal management review, HR procedures, complaints or root cause analysis. The local authority will request the outcome and a report within an agreed timescale. The local authority and the local Clinical Commissioning Group (CCG) as commissioners will require assurance that people have been safeguarded and appropriate action has been taken. All those carrying out such enquiries should have received appropriate training relevant to the type of enquiry. Referrals to professional regulatory bodies and the Disclosure and Barring Service must always be considered. The Local Authority will coordinate the S42 enquiry. The employer must report their findings and action plan to the local authority.

• A formal safeguarding enquiry under section 42 of the Care Act 2014 coordinated by the local authority or delegated partners.

The local authority will adopt the principle that the employer should investigate any concern (and provide any additional support that the adult may need) unless there is compelling reason why it is inappropriate or unsafe to do this. Examples of when this might occur include:

• A serious conflict of interest on the part of the employer
• Concerns having been raised about non-effective past enquiries
• Serious or multiple concerns
• Matters to be investigated by the Police

10.2 Consideration of the Safeguarding Referral by the Multi-Agency Safeguarding Hub

Multi-Agency Safeguarding Hub staff will use the risk assessment matrix to determine the level of risk and the appropriate response:

• Low – does not meet the grounds for s42 enquiry.
• Medium – may meet the threshold for a s42 enquiry.
• High – likely to meet the threshold for a s42 enquiry.

In determining a proportionate response, the priorities of the Multi-Agency Safeguarding Hub team must be to ensure the safety and protection of people with care and support needs and ensure their active participation. The team will establish the facts, assess the risk and agree an initial adult at risk plan for maintaining safety, wellbeing and dignity.

Where the case has been assessed by Multi-Agency Safeguarding Hub and the risk is perceived to be high the case will be progressed within 1 working day.

10.3 Notification to the Person Reporting the Safeguarding Concern

In all cases the person reporting the safeguarding concern will receive feedback from the Multi-Agency Safeguarding Hub, and they must be informed how the safeguarding referral will be dealt with within the confines of allowable information sharing. This will be within 7 calendar days of the decision.

11. Safeguarding Enquiries

11.1 Safeguarding Enquiry

An enquiry is the action taken or instigated by the local authority in response to a concern that abuse, or neglect may be taking place. An enquiry could range from a conversation with the adult at risk, prior to initiating a formal enquiry under S42 of the Care Act, right through to a full multi-agency plan or course of action. Whatever the course of subsequent action, the professional concerned should record the concern, the adult at risk views and wishes, any immediate action taken and the reasons for those actions. If the person lacks capacity, or has substantial difficulty in understanding the enquiry, their representative or advocate should be involved. The enquiry needs to include the wider context when considering the risk to the adult and to others.

The objectives of an enquiry into abuse or neglect are to:

• Establish facts
• Ascertain the adult at risk’s views and wishes
• Assess the risk to the adult at risk and to others
• Assess the needs of the adult at risk for protection, support and redress and how they might be met
• Protect the adult at risk from the abuse and neglect, in accordance with their wishes 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
• Enable the adult at risk to achieve resolution and recovery.

The Care Act 2014 states that local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult with care and support needs is or is at risk of being abused or neglected.

A Safeguarding Enquiry under section 42 of the Care Act will be undertaken when the concern meets all elements of the three-stage test for an adult at risk:

• A person aged 18 years or over has care and support needs and
• Is experiencing or at risk of abuse or neglect and
• As a result of their care and support needs is unable to protect themselves

It should be noted that the stages of the safeguarding process may overlap

11.2 Leading Safeguarding Enquiries

A formal enquiry under Section 42 of the Care Act 2014 would usually be coordinated by the local authority, or a partner with delegated authority under S75 NHS Act 2006

However, the 2014 Act allows the Local Authority to request this be undertaken by another agency using formal procedures most relevant to the concern. When such a request is made under section 42 of the Care Act 2014, there is a duty on partners to cooperate and respond.

The purpose of an enquiry is to decide whether or not the local authority or another organisation, or person, should act to help and protect the adult at risk.

The local authority will train a sufficient number of qualified professionals to undertake coordination of safeguarding enquiries. The aim is to ensure that effective action is taken to assess immediate risk and to address any immediate protection needs.

The practitioner leading the enquiry and their manager are responsible for coordinating the enquiry and for including all relevant agencies.

11.2.1 Lead Professional

The local authority is the lead agency for making enquiries, it may require others to assist with the process. In many cases a professional who already knows the adult at risk will be the person best placed to make the enquiries. They may be a social worker, a care provider, housing support worker or other health worker such as a community nurse.

Health and care providers may make enquiries regarding adults at risk in their service, and health providers can do so in health settings. All provider staff may support other agencies in an enquiry as they may know the adult at risk well. The only circumstances in which this cannot occur is if there are concerns that a provider will not be impartial as there are implications for their service, for example there are concerns about the way the service is run and they are the registered manager or owner.

Health and care providers cannot undertake enquiries if they do not have the skills or experience necessary to undertake an enquiry consistent with the requirements set out within the Care Act 2014, or if they have previously undertaken enquiries which have not met the requirements set out within the Care Act 2014.

Safeguarding leads may need to consult the other agencies involved in the enquiry strategy and review the enquiry plan. Should an agency fail to progress an agreed enquiry without informing the coordinating manager this will be escalated to a senior manager in their organisation and to the local authority Adult Safeguarding Manager. Should an adult at risk be placed at further risk the matter will be escalated to the Chair of the Adult Safeguarding Partnership Board as a failure of the duty to cooperate.

The role of the Local Authority in this process is to reduce risk and concentrate on the wellbeing of the adult going forward.

For further guidance and information on section 42 Enquiries see: https://www.adass.org.uk/media/7323/s42-fwork-v-7-5-final-11-july.pdf

11.2.2 Police Investigations into Criminal Cases

Where the abuse or neglect of an adult at risk amounts to a criminal offence the Police will lead the criminal investigation.

The Police will make a decision as to whether achieving a best evidence interview (ABE) is appropriate. The Local Authority will retain overall responsibility for the Safeguarding enquiry.

11.3 Safeguarding Issues to Consider

11.3.1 Abuse by and of unpaid carers

Circumstances in which an unpaid carer could be involved in a situation that may require a safeguarding response include:

• An unpaid carer may experience intentional or unintentional harm from the adult at risk they are trying to support or from professionals and organisations they are in contact with.
• An unpaid carer may intentionally or intentionally harm or neglect the adult at risk they support on their own or with others.

When a safeguarding concern is raised regarding a relative or unpaid carer, consideration should be given to the specific circumstances, the nature of the issues and the appropriate proportionate response. The decision should consider an outcome which supports or offers the opportunity to develop, or maintain, a private life which includes those people with whom the adult at risk wishes to establish, develop or continue a relationship.

Responses should ordinarily seek to support the continuation of family and caring relationships where this is consistent with the wishes and desired outcomes of those concerned. The Local Authority has produced a fact sheet “Supporting Carers at Risk of Abuse” which may be of help in these situations. See Appendix Seven.

11.3.2 Poor practice

When practices within an agency is judged as poor but has not yet lead to an adult at risk being harmed and are unlikely to do so imminently. It is important to consider the impact of the alleged harm or practice on the adult at risk, whether others may be at risk of harm, and what the proportional response to the concern should be. Where the practice is resulting in harm for the individual concerned, abuse is likely to be indicated. However, it is important to consider the nature, seriousness and individual circumstances of the incident in reaching a decision.

A commissioner or the Care Quality Commission can take action in respect of poor practice concerns, the local authority must consider if these actions already form an appropriate and proportionate response to the concerns raised.

If the local authority identifies possible abuse, including organisational abuse it will lead on those aspects of the concerns, performance and quality issues will continue to be addressed by commissioners and / or the Care Quality Commission.

11.4 Involvement of the Person (Adult at Risk)

The adult at risk should always be involved from the beginning of the enquiry unless there are exceptional circumstances. Where an adult at risk with mental capacity cannot be included as a full partner the practitioner leading the enquiry will agree with them how their views are to be incorporated into the planning process.

If the adult has substantial difficulty in being involved, and where there is no one appropriate to support them, then the local authority must arrange for an independent advocate to represent them for the purpose of facilitating their involvement.

If a person lacks capacity to contribute to the process, then consideration should be given to appointing an Independent Mental Capacity Advocate.

In all circumstances the adults at risk (or their advocate’s) views, wishes and desired outcomes from the safeguarding intervention should be gathered at the earliest opportunity as this should direct the subsequent planning.

The most important support is the creation and implementation of a robust adult at risk plan to address immediate risks and longer-term support.

Where possible, as appropriate to the case and with the adult at risk’s agreement the adult at risk must be supported to:

• Live free from continuing abuse
• Build their confidence, self-esteem and acknowledgement of their right not to be abused
• Enable access to people outside the abusive situation, for example, social or educational activities
• Access services where they can talk about the abuse they are experiencing, e.g. counselling services, victim support, domestic abuse outreach services or other support group
• Gain more information about their options, e.g. advocate or legal advice
• Make a plan about what they would do if they changed their mind or if they wanted help in an emergency
• The information obtained during the visit must contribute to a judgement of the level of risk to independence of the adult and to other people with care and support needs that might also be at risk.
• Support from partner agencies must be obtained promptly if there is a need for them to act with urgency in order to prevent further harm until a planning meeting has taken place.

Guidance on understanding the ‘Lived Experience of the Adult’ to support enquiries and assessments can be found here: Lived Experience of the Adult | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

11.4.1 Consent and Information gathering

When contacted as part of information gathering, the adult at risk may have decided to withhold consent for information sharing for any further adult safeguarding process. The adult safeguarding staff should check that the adult at risk has had a full explanation of what the adult safeguarding procedures involve. A decision on whether to proceed or not should be based on an assessment of whether the conditions to override consent are met, i.e. that it is in the public interest,

If the decision is made to progress without the adult at risk’s consent the adult at risk should be advised of this, unless to do so would put them at risk, and involvement offered on whatever basis the adult is comfortable with. It is the local authorities’ decision not to follow its section 42 duty, if the decision is to stop the adult safeguarding procedures the adult at risk should receive clear information on how to get help if they wish to, or if matters deteriorate. The rationale for the decision not to proceed should be clearly recorded by the decision maker.

If the person with care and support needs does not want intervention and they have the capacity to make this decision, and if there are no other grounds or a legal requirement to intervene, it is still possible to work alongside him/her – with their consent. Examples of this might include:

• A Care Act assessment of need
• Providing information about alternative sources of support and advice
• Options to increase personal or environmental safety
• The provision of advocacy

11.4.2 Advocacy

In all cases professionals should consider if the adult at risk needs and advocate or someone to support them.

Under the Care Act 2014 the local authority has the duty to provide professional independent advocacy to people (adults and carers) with care and support needs:

• Who may have capacity but would have substantial difficulty (understanding retaining weighing up, communicating) in being involved in care and support processes (subject of a safeguarding enquiry and / or safeguarding adult review)
• When there is no other suitable person to represent and support them
• Advocacy must be independent of the local authority

The advocate’s role is to facilitate the person’s involvement, not merely be consulted about it. Advocates will decide the best way of supporting and representing the person they are advocating for, always with regard to the wellbeing and interest (including their views, beliefs and wishes) of the person concerned.

If a safeguarding enquiry needs to start urgently then it can begin before an advocate is appointed but one must be appointed as soon as possible.

If the person has been assessed as lacking the capacity to make decisions concerning the abuse and there are no family members or relevant others to act in their best interests, an Independent Mental Capacity Advocate (IMCA) must be appointed. An Independent Mental Capacity Advocate is a statutory advocate introduced by the Mental Capacity Act 2005, appointed to support a person who lacks capacity.

The Independent Mental Capacity Advocate makes representations about the person’s wishes, feelings, beliefs and values, bringing to the attention of the decision-maker all factors that are relevant to the decision. The IMCA can challenge the decision-maker on behalf of the person lacking capacity if necessary.

Where an independent advocate has already been arranged under s67 Care Act or under MCA 2005 then, unless inappropriate, the same advocate should be used for safeguarding purposes.

Think and ask about the advocacy services being used in your area

11.4.3 Right to Refuse Services or Support

When the adult at risk who is alleged to have been harmed has capacity and does not want any information to be shared this must be honoured unless any authority has an overriding duty of care to act, or other people with care and support needs or children are at risk. If you have any doubt about this, you should consult your manager or the Safeguarding Team for advice.

In situations where:

• There is a legal duty of care to do so
• The alleged person causing harm is a paid worker, volunteer or in a position of trust
• The person alleged to be causing harm is another person with care and support needs
• Other people are at risk from the alleged person causing harm
• Then enquiries may take place even where a person with care and support needs, with or without mental capacity, has asked for no action.

The Local Authority has a duty to make enquiries, protect and check all of the facts before reaching a final decision on how to proceed.

11.5 Information Sharing

It is a requirement for all staff to treat all information in a confidential manner and use it solely for lawful purposes in accordance with acts of legislation and national guidance, specifically the Data Protection Act 2018, the General Data Protection Regulation (GDPR), the Care Act 2014 and the Caldicott Principles.

This section sets out how Cambridgeshire and Peterborough Safeguarding Adults Partnership Board requires confidential information to be kept safe and secure, without compromising the need to share information appropriately and lawfully to safeguard adults at risk.

11.5.1 Information sharing and safeguarding

There is a common law “Duty of Confidence”, where a person has a right to expect information given in confidence to be kept confidential by the person receiving the information i.e. doctor and patient, solicitor and client.

Effective information sharing is key to effective safeguarding. It is therefore important that a balance is found between maintaining confidentiality and sharing information on a need to know basis with relevant parties.

11.5.2 Why do we need to share adult safeguarding information?

According to the Social Care institute for Excellence, organisations need to share safeguarding information with the right people at the right time to:

• prevent death or serious harm
• coordinate effective and efficient responses
• enable early interventions to prevent the escalation of risk
• prevent abuse and harm that may increase the need for care and support
• maintain and improve good practice in safeguarding adults
• reveal patterns of abuse that were previously undetected and that could identify others at risk of abuse
• identify low-level concerns that may reveal people at risk of abuse
• help people to access the right kind of support to reduce risk and promote wellbeing
• help identify people who may pose a risk to others and, where possible, work to reduce offending behaviour
• reduce organisational risk and protect reputation

Safeguarding adults: sharing information | SCIE

The Data Protection Act 2018, and the General Data Protection Regulation (GDPR) are not barriers for sharing information. They provide a documented framework for sharing information securely and appropriately. The act allows the balance of the need to preserve a trusted relationship with the need to share information to effectively safeguard the person.

It is crucial to remember that there can be significant consequences to not sharing information, as there can be to sharing information. Professional judgement must be exercised in making the decision to share, or not share information, and the reasoning documented. All sharing of personal information must be lawful.

11.5.3 Lawful Information sharing

There are four legal bases for processing personal confidential data which meet the common law duty of confidentiality. These are:

1. With the consent of the individual concerned.
2. Through statute, such as the powers to collect confidential data in section 251 of the NHS Act 2006 (see section 6.7) and the powers given to the Information Centre in the Health and Social Care Act 2012 (see sections 1.8, 6.5 and 7.3.4).
3. Through a court order, where a judge has ordered that specific and relevant information should be disclosed and to whom; and
4. When the processing can be shown to meet the ‘public interest test’, meaning the benefit to the public of processing the information outweighs the public good of maintaining trust in the confidentiality of services and the rights to privacy for the individual concerned.

In addition to having one of these legal bases, the processing must also meet the requirements of the Data Protection Act 2018 and pass the additional tests in the Human Rights Act 1998.

Any processing of personal confidential data that is not compliant with these laws, even if otherwise compliant with the Data Protection Act 2018, is a data breach, and must be dealt with as such.

11.5.4 Informed Consent

Issues concerning consent can be complex, and it may be appropriate to seek guidance.

Consent must be ‘informed’. This means that the person giving consent needs to understand why information needs to be shared, what will be shared, who will see their information, the purpose to which it will be put and the implications of sharing that information.

There will be cases where the adult at risk may have the cognitive capacity to make decisions and give consent but where their context and history mean that they are unable to make a realistic, independent and informed decision about their own needs and safety. Professionals should explore alternative routes to safeguard the adult, including through legal processes and the use of inherent jurisdiction, proportionate to the risk of serious harm.

Obtaining explicit consent for sharing information is best practice and should be obtained from the adult at risk at the start of any involvement. It can be expressed either verbally or in writing, although written consent is preferable since that reduces the scope for subsequent dispute.

If there is a significant change in the use to which the information will be put compared to that which had previously been explained, or a change in the relationship between the agency and the individual, consent should be sought again. Individuals have the right to withdraw consent at any time.

It is important to distinguish between serious harm to the person to whom information relates and serious harm to others. Confidential information can be disclosed without consent to prevent serious harm or death to others. This is likely to be defensible in common law in the public interest.

11.5.5 Legislative Basis for Information Sharing

For further details relating to the legislative basis for sharing information including various legislative acts and the Data Protection Act 2018 – see Appendix Eight.

11.5.6 Caldicott Principles

For further details please see Appendix Eight

For guidance on the Golden Rules of Information sharing please see Appendix Eight

11.5.7 Information Sharing Principles

There are a number of principles, which are non-statutory, to support decisions to share confidential information. These principals may be agency specific and could also be a part of an agreed memorandum of understanding. Ask your agency if any of these apply.

11.6 Involvement and Support for Family and Carers

The nature of some safeguarding concerns, especially any incident involving serious harm, may also cause distress to the family and carers of the adult at risk. It is an important role for the practitioner leading the enquiry to consider whether any support is required or referral to a statutory agency or other recognised body. Any safeguarding enquiry following the death of a person with care and support needs should specifically consider this.

If a carer experiences intentional or unintentional harm from the adult they are supporting, or if a carer unintentionally or intentionally harms or neglects the adult they support, consideration should be given to:

• Whether, as part of the assessment and support planning process for the carer and, or, the adult they care for, support can be provided that removes or mitigates the risk of abuse. For example, the provision of training or information or other support that minimises the stress experienced by the carer. In some circumstances the carer may need to have independent representation or advocacy; in others, a carer may benefit from having such support if they are under great stress or similar
• Whether other agencies should be involved; in some circumstances where a criminal offence is suspected this will include alerting the police, or in others the primary healthcare services may need to be involved in monitoring

Other key considerations in relation to carers should include:

• Involving carers in safeguarding enquiries relating to the adult at risk they care for, as appropriate
• Whether or not joint assessment is appropriate in each individual circumstance
• The risk factors that may increase the likelihood of abuse or neglect occurring
• whether a change in circumstance changes the risk of abuse or neglect occurring

11.7 Undertaking a Safeguarding Enquiry

Procedures and Guidance on how to undertake a safeguarding enquiry can be found in Appendix at Nine and may include:

1. Initial information gathering
2. Planning as part of a safeguarding enquiry
   1. Primary considerations for Adult at Risk Planning
   2. Services Implicated in Abuse & Care Quality Commission (CQC)
   3. People alleged to be causing harm who have Care and Support Needs
   4. Involvement of the Alleged Person Causing Harm in discussions and meetings in Very Exceptional Circumstances
3. Holding Adult at Risk Meetings
   1. Key Areas for consideration in Adult at risk meeting
   2. Adult at Risk Meeting Conclusions
4. Adult At Risk Plans
   1. Positive Actions to Prevent Repeat Abuse, or Neglect by a Person or an Organisation
   2. Actions to Promote the Safety of an Adult and for Recovery from Abuse, or Neglect
   3. Actions to be considered in relation to the person alleged to be causing harm include:
   4. Review and Closure of the adult at risk Plan
5. Records
   1. Keeping accurate records of an enquiry
   2. Guide for what to include in an enquiry report

11.8 Effective outcomes

It is important to know how effective the adult safeguarding intervention has been. For this reason, it will be necessary to record identification and responses to risk. See Appendix Ten– Risk Framework tool.

11.9 Resolving Professional Differences (Escalation Process)

Key Principle: It is every professional’s responsibility to ‘problem-solve’. The aim must be to resolve a professional disagreement at the earliest possible stage as swiftly as possible, always keeping in mind that the adult at risks safety and welfare is the paramount consideration.

The Cambridgeshire and Peterborough Safeguarding Adults Partnership Board is clear that there must be respectful challenge whenever a professional or agency has a concern about the action or inaction of another. Examples could include

1. there may be disagreement as to the Multi-Agency Safeguarding Hub outcome or
2. which agency should undertake an enquiry

• an agency fails to meet timescales or does not undertake the recommended actions or fails to communicate the outcome.

Agencies/professionals should not be defensive if challenged.

It is expected that the Safeguarding Adult Partnership Board escalation and resolution process should be used first, however if at any stage it is felt necessary to make a formal complaint, each agency should follow the recognised complaints procedure and adhere to the timescales specified. The Resolving Professional Differences policy can be found at:

Safeguarding Adults Resolving Professional Differences (Escalation Policy) | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

12. Safeguarding Adult Reviews (SARs)

According to Part One Section 44 of the Care Act 2014 Safeguarding Adult Boards (i.e. Cambridgeshire and Peterborough Safeguarding Adult Partnership Board) must undertake a Safeguarding Adult Review (SAR) when:

1. An adult in its area with care and support needs (i.e. an adult at risk) has died as a result of abuse or neglect whether this was known or suspected before the adult died and there is concern that partner agencies could have worked more effectively to protect the adult.
2. An adult in its area with care and support needs (i.e. an adult at risk) 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.

The purpose of a Safeguarding Adults Review is to learn the lessons about how professionals and organisations work together, and to consider how the learning can be used to improve practice for others in the future

Appendix One : Types of Abuse

The following are defined by Care Act 2014 guidance as constituting abuse or neglect. However Local authorities should not limit their view of what constitutes abuse or neglect, as they can take many forms and the circumstances of the individual case should always be considered; although the criteria below will need to be met before the issue is considered as a safeguarding concern.

The following gives examples of possible abuse of adults at risk and indicators:

Appendix Two: How to Respond to Disclosures of Abuse and Neglect

Once an adult at risk has disclosed abuse it is important that the adult at risk is supported throughout the safeguarding process:

• Remain calm and do not show shock or disbelief
• Help the adult at risk to stay in control and find out what they want to happen next
• Listen carefully to what is being said using aids where necessary to support communication. Record it in detail using the words that they used
• Use open ended questions using TED principles; Tell me, Explain, Describe.
• Be aware of the possibility that medical evidence may be needed
• Demonstrate an empathetic approach by acknowledging regret and concern that what has been reported has happened
• Do confirm that the information will be treated seriously
• Give the person contact details so that they can report any further issues or ask any questions that may arise
• Ensure that the person with care and support needs receives regular feedback and updates, in the format that best suits their needs
• Ensure that any emergency action needed has been taken
• Ensure that those who need to be informed have been informed

Tell the person that:

• It was not their fault and they were right to tell you
• You must inform an appropriate Manager and/or the Police
• The Manager will contact the Multi-Agency Safeguarding Hub
• The Multi-Agency Safeguarding Hub will consider the adult at risk wishes and whether they consent to the matter being progressed further. There will be circumstances where an enquiry may have to progress even if they do not give their consent
• Do not press the person for more details
• But do not stop someone who is freely recalling significant events, as they may not tell anyone again
• Do not dismiss or disbelieve what you see or have been told
• Do not ignore the issue
• Do not promise to keep secrets; but do explain that the information will only be passed to those who “need to know”, and try to be specific about who these might be
• Do not make promises that you cannot keep (such as “this will not happen to you again”)
• Do not contact the alleged abuser or anyone who might be in touch with him / her
• Do not be judgmental e.g. “why didn’t you run away?”
• Do not tell anybody who doesn’t need to know – remember the rules of confidentiality
• Do not ask leading questions e.g. suggesting names of who may have perpetrated abuse if the person does not disclose it

Appendix Three: How to Make a “Good” Referral

Firstly, before making a safeguarding referral consider is this person I am concerned about an adult at risk?

Remember:

According to the Care Act 2014: An Adult at Risk (sometimes referred to as AAR) is an adult (someone aged 18 or older) who:

1. has needs for care and support (whether or not the authority is meeting any of those needs),
2. is experiencing, or is at risk of, abuse or neglect, and
3. as a result of those needs, is unable to protect himself or herself against the abuse or neglect or the risk of it.

Secondly is the concern I have about the adult at risk a Safeguarding Concern?

If it is a safeguarding concern that you have about an adult at risk then you must complete all of the relevant sections on the safeguarding referral form with as much detail as possible, including:

• Your details (name, job title) and contact information (telephone contact and address)
• Details of the adult at risk – (correct spelling of name, ethnicity, date of birth, address, first language etc)
• Details of the adult at risk safeguarding concern – what are you concerned / worried about? What is the impact on the adult at risk? Has any previous support been provided to address these concerns and what are the strengths/ resilience factors for the adult at risk?
• Has the adult at risk involved given consent to the referral being made? If you have not gained the adult at risk consent, then you need to say why
• Details of the incident/concern, including dates and times and list any actions taken to safeguard the individual
• Details about the person alleged to be causing harm, including name and address, the relationship to the person with care and support needs, their role and the organisation for which they work,
• Consideration of whether or not there is a risk of abuse to others, including children.
• Consideration of Making Safeguarding Personal and the Lived Experience of the Adult – have you asked the adult what outcome they would like following the safeguarding referral?
• What do you want to see happen as a result of the safeguarding referral?
• Addition of multi-agency risk assessments that will support your referral
  • Hoarding Risk Assessment Tool
  • Clutter Image Rating Tool
  • Self-Neglect Indicator Assessment Tool
  • Self-Neglect Assessment of Need and Risk
  • Pressure Ulcers
  • DASH (Domestic Abuse, Stalking and Honour based violence)

These assessments can be found at Concerned? | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

• Practice Guidance on Pressure Ulcers | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)
• DASH form, guidance and flowchart https://www.cambsdasv.org.uk/website/referral_forms/296136

Remember, facts and opinion should be clearly differentiated. Referral forms should be completed without the use of jargon, technical terms, and derogatory and discriminatory language. If you do use technical and medical terms, then you should explain what they mean for the adult at risk.

Remember, the more information that is provided, the easier it is for the MASH(Multi-Agency Safeguarding Hub) to make a decision about the best course of action to take.

Appendix Four: Multi- Disciplinary Team Meetings

CCC and PCC Practitioner Factsheet: Management of Meetings

Taken from Peterborough City Council and Cambridgeshire County Council Fact Sheet Management of Meetings

Appendix Five: How to Record and Store Information

1. Recording a Safeguarding Concern / Safeguarding Disclosure

Concerns about abuse must be recorded as soon as possible and always on the same day.

• Records should be given to your Line Manager.
• Records of concerns and disclosures of abuse are strictly confidential.
• Reports should not be entered into a record or file to which people who do not need to know, or an alleged abuser, may have access.
• Write it as soon as you possibly can after the disclosure so you remember as much as you can.
• Write down exactly what the person said, for example if an adult says “he touched me down there” write this down, do not write “she said he touched her vagina”.
• Include the following:
  • Where the abuse took place
  • Whether anybody else was present.
  • Who has been abused, where and when
  • What was the impact of the abuse
  • Who was involved in the abuse
  • Were there any issues about the mental capacity of those involved at the time of the incident
  • Immediate actions taken to protect the person with care and support needs
  • does anyone else involved have care and support need
• If you make a mistake, put a line through it, do not use Tippex.
• Use a pen or a biro, preferably with black ink for photocopying.
• Sign the report, date and time it.
• Be aware that the report may be required later as part of legal action or disciplinary procedure and that you may need to appear at a hearing or court.
• You should record full details on the Safeguarding Referral form, where possible

2. Keeping Agency Records

• Each person of concern should have their own individual record
• Records must be kept from the time that a safeguarding concern, allegation or disclosure is made
• When recording a safeguarding concern don’t forget to describe what you have seen, heard or have been told …write down
  • Who
  • What
  • Where
  • When
• Records should be signed and dated
• Records must be made as soon as possible after the event
• Always check accuracy, particularly after recording in a stressful situation
• All records should be typed or kept on computer
• All records must be securely stored in accordance with your own agency policies
• All safeguarding meeting minutes must be kept on the adult at risk’s file
• All safeguarding plans and reviews must be kept with the adult at risk’s file
• If the alleged person causing harm is accessing services then information about his or her involvement in a safeguarding enquiry including the outcome of the enquiry must be included on his or her case records
• It is inappropriate to document certain information in the place normally used for records, if the suspected alleged person causing harm or associates may have access to that record.

Appendix Six: Guidance on Determining the relevant Local Authority

Responsibility for leading an enquiry lies with the area where the alleged abuse took place.

Some adults at risk living in these areas are the responsibility of other local authorities. For the purposes of this section the area in which they are living is the “host authority” and the area with funding responsibility is the “placing authority”.

The guidance in this section is taken from the ADASS Safeguarding Adults Policy Network Guidance on Out-of- Area Safeguarding Adults Arrangements (December 2016).

The following principles underpin the guidance in this document:

• The host authority will have overall responsibility for co-ordinating the safeguarding adults’ enquiry and for ensuring clear communication with all placing authorities and other stakeholders, especially with regards to the scheduling of meetings and the planning of the enquiry.
• The placing authority will have a continuing duty of care to the person with care and support needs that they have placed.
• The placing authority will contribute to the enquiry as required and maintain overall responsibility for the individual they have placed.
• The placing authority should ensure, through contracting arrangements and in-service specifications, that the provider has arrangements in place for protecting people with care and support needs and for managing concerns, which in turn link with local (host authority) multi-agency safeguarding adults procedures. This includes the requirement to inform the host authority of both individuals and placing authorities affected by the safeguarding concerns.
• Authorities may negotiate flexible arrangements, for example relating to another authority undertaking assessments, reviews, investigative activities or other supportive activities on behalf of a placing authority. In such cases, the placing authority would maintain overall responsibility for the person they have placed, and reimbursement would be required and agreed as part of such negotiations.

1. Hospital Settings:

If a safeguarding concern is reported and the alleged abuse occurred within a hospital setting in Cambridgeshire or Peterborough, the Council in whose area the alleged abuse occurred will assume responsibility for the enquiry. If the adult at risk is an ordinary resident of a different Authority, they will be contacted as part of the planning process.

If the abuse occurred prior to admission, the council in whose area the alleged abuse occurred must be asked to take over the lead role in the investigation. In these cases, a worker / workers from Cambridgeshire or Peterborough as appropriate may be allocated to support the home authority with their investigation.

2. Community Settings:

People with care and support needs using services may disclose abuse that has happened in their placing authority. In these circumstances, the appropriate manager in this area will support the person receiving the concern to report the concern to the relevant local authority.

The lead role in enquiries into alleged abuse that occurred in Cambridgeshire or Peterborough will be taken by services from that area. This applies if the person alleged to have been harmed lives in another area unless transfer of leadership is agreed by the Safeguarding Managers of both councils. In these circumstances, the Adult Safeguarding Team will liaise with the Adult Safeguarding Manager in the person’s placing authority.

3. What may fall outside the duty of the local authority?

1. Information gathering may conclude that the section 42 duty to enquire is not met because the concern raised with the local authority does not relate to:
   
   1. An adult at risk
   2. An issue of abuse or neglect (including self-neglect) as defined within the Care Act 2014

      However, the people concerned may need support. The local authority should consider how it can provide or direct the person to more appropriate forms of support in relation to their needs.

2. The concern may relate to an historical allegation of abuse and the adult with care and support needs is now no longer at risk. One of the criteria for undertaking a statutory enquiry under the Care Act 2014 s42 duty is that the adult with care and support needs is “experiencing, or is at risk of, abuse or neglect”. Therefore, the duty to make enquiry under the Care Act 2014 relates to abuse or neglect, or a risk of abuse or neglect that is current. Concerns relating to historic abuse or neglect where the person is no longer at risk will not be the subject of statutory enquiry under these procedures, but further action under different processes may be needed
   
   All such historic safeguarding concerns will be considered to determine whether they demonstrate a potential current risk of harm to other adults. If so a section 42 enquiry will be appropriate to determine whether other adults with care and support needs are in need of safeguarding. Criminal or other enquiry through parallel processes (e.g. complaints, inquests, regulatory, commissioning, health and safety investigations) may be indicated.
3. An historic concern regarding child sexual abuse or exploitation must include a consideration of whether children are currently at risk of abuse from the same perpetrator. If it is believed children are at risk a report must be made to children’s social care MASH. The police will still consider allegations of historical abuse should the adult wish to report this.
4. Where an adult safeguarding concern is received for an adult who has died the same considerations will apply. An enquiry will only be made where there is a clear belief that other identifiable adults with care and support needs are experiencing, or are at risk of, abuse or neglect. If there are concerns about how an adult died but there is no risk to any other adult at risk the matter should be reported to the local coroner’s office or police. A referral for a Safeguarding Adult Review (SAR) may be appropriate where there are concerns about the circumstances of the death

Appendix Seven: Practitioner Factsheet Supporting Carers at Risk of Abuse

The eligibility criteria with support needs under the Care At 2014 states that carers can be eligible for support in their own right based on the impact that the caring role has on their wellbeing.

In this responsibility it is important to consider carers who are a significant risk of abuse due to the nature of their caring role.

It is also important to note that a carer may be at risk of abuse or suffering abuse from the cared for person.

Indicators to consider when suspecting carer abuse by adult at risk:

• Risk of abuse can increase when carer is isolated.
• Cared for person does not acknowledge that the carer has needs and is unaware or in denial of the impact their behaviour has on the carer.
• Unrealistic expectations by cared for person on the carer.
• The cared for person does not treat the carer with respect and uses emotional strategies to control them.
• The cared for person rejects outside help from other family members and will not engage with any attempts to provide formal help
• The cared for person refuses to be left alone – even for short periods of time and sabotages any attempts the carer makes to create space between themselves and the cared for person
• The cared for person displays aggressive behaviour or abusive behaviours towards the carer
• The carer may not have an independent source of income; their income relies on them remaining a carer
• Imbalance of power with regards to finances and accommodation.
• The cared for person has a history of substance abuse.
• There is a history of domestic violence.
• In extreme situations the carer may feel like the only way to escape is to take their own life.

Although a S42 enquiry may not be required / appropriate safeguarding principles should still be applied to support and safeguard the carer at risk of abuse.

Appendix Eight: Information Sharing

1. Legislative bases for information sharing

According to the Care Act 2014 – A Safeguarding Adult Partnership Board may request a person to supply information to it or to another person. The person who receives the request must provide the information to the safeguarding adult partnership board if:

• the request is made in order to enable or assist the safeguarding adult partnership board to do its job
• the request is made of a person who is likely to have relevant information and then either:
  • the information requested relates to the person to whom the request is made and their functions or activities
  • the information requested has already been supplied to another person subject to an SAB request for information

(Care and Support Statutory guidance Feb. 2017) The Care Act therefore provides one legal basis for sharing information.

Crime and Disorder Act 1998 S.115

This allows information to be shared with the police, a local authority or a health authority if it is necessary or expedient for the purposes of any provision of this Act.

Data Protection Act 2018, General Data Protection Regulation (GDPR) S29

Information for:

1. The prevention or detection of crime,
2. The apprehension or prosecution of offenders,

Is exempt from the first data protection principle (except to the extent to which it requires compliance with the conditions in Schedules 2 and 3) (see appendix 2 DPA schedules)

Data Protection Act – Data Principles

• Personal data shall be processed fairly and lawfully and, in particular, shall not be processed unless: E+W+S+N.I
  • at least one of the conditions in Schedule 2 is met, and
  • in the case of sensitive personal data, at least one of the conditions in Schedule 3 is also met.
• Personal data shall be obtained only for one or more specified and lawful purposes, and shall not be further processed in any manner incompatible with that purpose or those purposes. E+W+S+N.I
• Personal data shall be adequate, relevant and not excessive in relation to the purpose or purposes for which they are processed. E+W+S+N.I
• Personal data shall be accurate and, where necessary, kept up to date. E+W+S+N.I
• Personal data processed for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes. E+W+S+N.I
• Personal data shall be processed in accordance with the rights of data subjects under this Act. E+W+S+N.I
• Appropriate technical and organisational measures shall be taken against unauthorised or unlawful processing of personal data and against accidental loss or destruction of, or damage to, personal data. E+W+S+N.I
• Personal data shall not be transferred to a country or territory outside the European Economic Area unless that country or territory ensures an adequate level of protection for the rights and freedoms of data subjects in relation to the processing of personal data.

2. Caldicott principles

Justify the purpose (What is the purpose of the information sharing — is there a clear objective that can best be achieved by sharing the data?)

• Don’t use personal confidential data unless it is absolutely necessary
• Use the minimum necessary personal confidential data
• Access to personal confidential data should be on a strict need to know basis.
• Everyone with access to personal confidential data should be aware of their responsibilities
• Comply with the law
• The duty to share information can be as important as the duty to protect patient confidentiality. (What is the risk to individuals (both the person and any third parties) of sharing the data and is this risk proportionate to the benefits to the individual that will be achieved? This includes considering if there is a risk to individuals if the data is not shared.)

3. Golden rules of information sharing

The 7 golden rules of information sharing were developed for children’s safeguarding and can help support the decision to share information legally and in the best interests of the person or the wider public. The 7 golden rules are:

1. Remember that the Data Protection Act 2018, General Data Protection Regulation (GDPR) and human rights law are not barriers to justified information sharing but provide a framework to ensure that personal information about living individuals is shared appropriately.
2. Be open and honest with the individual about what information may be shared and with whom.
3. Seek advice from other practitioners if you are in any doubt about sharing the information concerned, without disclosing the identity of the individual where possible
4. Share with informed consent where appropriate and, where possible, respect the wishes of those who do not consent to share confidential information. You may still share information without consent if, in your judgement, there is good reason to do so.
5. Consider safety and wellbeing: Base your information sharing decisions on considerations of the safety and well-being of the individual and others who may be affected by their actions
6. Necessary, proportionate, relevant, adequate, accurate, timely and secure: Ensure that the information you share is necessary for the purpose for which you are sharing it, is shared only with those individuals who need to have it, is accurate and up to date, is shared in a timely fashion, and is shared securely
7. Keep a record of your decision and the reasons for it, whether it is to share information or not. If you decide to share, then record what you have shared, with whom and for what purpose

Safeguarding adults: sharing information | SCIE

Appendix Nine: Undertaking Safeguarding Enquiries – What To Do..

1. Initial information gathering

At the outset the lead investigator should:

• Check that the adult at risk consents to the enquiry progressing, including the sharing of information. Seek written consent where possible.
• Gain information about actions needed that will enable the adult at risk to participate in the process, for example communication needs and/or physical access needs. Determine the adult at risk’s physical and emotional needs and ensure that their safety and wellbeing are protected.
• Enable the adult at risk to make informed choices about the safeguarding process, including their wishes and expectations of the outcome.
• Ask the adult at risk for their own account of any situations highlighted in the safeguarding concern, (subject to possible consultation with the Police in cases of suspected crime) and to assess any risk of abuse they may be facing
• Where there is any cause to suspect/reasonable belief that there is an impairment of, or a disturbance in the functioning of, the mind or brain, assess the person’s capacity to make informed choices about actions that could be taken to decrease any risk of abuse
• Establish whether they give consent (if they are able to) for family members and/or informal carers to be informed and whether they wish them to be included in any adult at risk meetings/case conference. This consent can be overridden in the circumstances outlined on page (procedures)
• Inform the person with care and support needs and their family/supporters of their rights to make formal complaints and/or take civil action.
• Offer advocacy services.
• Establish what the allegations of abuse are.
• Assess the presenting risks and agree protection arrangements.
• Obtain evidence.
• Give information about the input that partner organisations could make to the risk assessment and to any safeguarding plan.
• Explain any actions that an organisation has a duty to take, as a result of the referral and the interview, including actions to reduce immediate risk.

2. Planning as part of an Enquiry

Those responsible for conducting the enquiry should work with the adult at risk to develop an adult at risk plan. This may involve a discussion with other agencies or an adult at risk meeting.

An Adult at Risk meeting should involve the adult at risk concerned, (and / or their advocate or representative), the practitioner leading the enquiry, other professionals and managers as appropriate who will be able to provide necessary information to support with formulating a strategy for the enquiry. On other occasions it will be necessary or more effective, to formulate the initial plan through a series of telephone conversations, e-mails, or through a virtual meeting or a discussion. The practitioner leading the enquiry must decide on which course of action is most appropriate taking account of the level of risk and complexity of each case and the wishes of the adult at risk concerned.

It is important to remember that planning discussions may need to take place immediately following the Multi-Agency Safeguarding Hub’s (MASH) decision and prior to the initial safeguarding visit. The planning discussion may take place with the MASH Safeguarding Team during the initial decision stage of the enquiry. It is the responsibility of the practitioner leading the enquiry to ensure that this is properly recorded on the safeguarding record.

The timing of planning discussions/meetings will be determined by the level of risk and urgency presented but should not in any case prevent effective support planning proceeding without delay.

All partner organisations involved must work actively to contribute to the plan and share their information appropriately.

Primary Considerations for Adult at Risk planning

• The wishes, feelings and desired outcomes of the adult at risk concerned -what the adult at risk wants to happen
• The protection of the adult at risk concerned
• The dignity, safety and wellbeing of the adult at risk concerned
• Clarify which issues are within the scope of the enquiry
• The identification and protection of anyone else who may be at risk especially the safety of those who raised the concern
• Obtain background information and establish matters of fact
• Gathering of initial evidence to enable action to be taken against the alleged person causing harm, e.g. by Police, CQC, or their employer. Care should be taken throughout that actions do not prejudice the gathering of evidence by partner organisations, especially in a Police enquiry.
• Thorough assessment and analysis of risk
• Minimising the impact of the alleged abuse for the adult at risk who may have been harmed or their main carers. Care should be taken to ensure that the adult at risk experiencing abuse is not asked about what has happened to them more than necessary but is sensitive to the adult at risk’s need to discuss their experience
• Determining roles and responsibilities for each agency (e.g. Local Authority, Police, Health, Provided Services, etc.).
• Agree timing of actions (including complaints and staff disciplinary).
• Consider whether concerns warrant a recommendation for suspension of NHS or local authority placements or service contracts
• Need for expert legal advice or opinion.

Services Implicated in Abuse & Care Quality Commission (CQC)

Where a service is implicated in abuse or neglect, contact will be made with the management of the service and with service commissioners who will be invited to contribute to the planning. Where this is a registered service Care Quality Commission (CQC) must be consulted.

A decision should be made as to how and at what level of seniority a representative of the service involved can appropriately be involved in all or part of the planning process. This includes a judgment as to whether they are likely to be implicated as party to the alleged abuse/neglect or a potential witness in a criminal enquiry.

People alleged to be causing harm who have Care and Support Needs

If the person alleged to be causing harm is accessing services or may be in need of health or care services, the practitioner leading the enquiry, in consultation with other agencies, must ensure that decisions are made and clear plans are in place in relation to:

• The provision of services or change in provision of services to that adult at risk in the context of the allegations
• The safety of other adults at risk accessing services,
• Reducing any trauma experienced by the adult at risk who has experienced abuse
• The need to pass on any information about allegations to other people. This must be done lawfully
• If there is need to pass information to another agency this must be done either with the signed consent of the person against whom the allegations have been made or on the basis of information that needs to be shared for the purpose of preventing crime or further abuse of others

The provision of services to enable the person to recognise the impact of their behaviour and to choose not to carry out abusive behaviour in the future

Involvement of the Alleged Person Causing Harm in discussions and meetings in Very Exceptional Circumstances

It is unlikely that the person alleged to have caused harm would be included in planning discussions. This would happen in very exceptional circumstances and with the agreement of the Chair of the meeting.

It may form part of the planning for the alleged person causing harm to be present at a meeting; for example, if information and support to an informal carer who has been neglecting a person’s care needs is a key part of the protection plan. This must also be with the informed consent of the person. If they do not have the capacity to make this decision, then a best interest decision should be made in accordance with the Mental Capacity Act. Any such decision must be clearly documented, and safeguards put in place to ensure the wellbeing and support of the adult at risk.

Where the allegation is against an agency rather than a member of staff, consideration should be given to whether or not to include the agency in any meetings and if included what level of staff should be invited.

Holding Adult at Risk Meetings

In some cases it may be appropriate to hold an Adult at risk meeting to coordinate a multi-agency response and produce a Safeguarding plan

The objectives of an adult at risk meeting would be to

• Collate information
• Review what the adult at risk wants to happen
• Review the support being offered to the adult at risk
• Review risks
• Draw up or review adult at risk plans
• Make decisions
• Review the enquiry report
• Determine whether abuse has occurred

The practitioner leading the enquiry is responsible for ensuring that the relevant organisations are informed of the need for a meeting and that they are invited.

The adult at risk and / or their advocate should be invited unless there is a valid reason why this should not happen. There should be evidence or serious suspicion that:

• There is a significant risk to the well-being of the adult at risk through attendance
• More than one adult at risk may be involved and confidentiality may be at risk (consideration should be given to having several parts to the meeting where possible)
• There is a likelihood that a police investigation may be compromised
• There is a possibility that risk to others may ensue

If the adult at risk does not attend the meeting plans must be made for how they will be informed about the meeting and any decisions made.

Key Areas for consideration in Adult at Risk meeting

The following areas should be considered and recorded in the Adult at risk meeting

• Background Details to the concern
• Summary information about the person with care and support needs, age, health, status, social living and support arrangements, relevant capacity
• Brief outline of current well-being / situation of the person with care and support needs and their views about the outcomes they want
• Discussion of any public interest considerations
• Risk Assessment
• Risks to and safety of person with care and support needs
• Risks to and safety of other people with care and support needs or children
• Whether any employee or volunteer should be suspended pending enquiry
• Where staff are suspended, the impact of that suspension on the service, people accessing the service, employer and employee and the steps needed to preserve continuity of services
• Whether remedial actions are required to protect other people with care and support needs or children
• The need for advocacy if not previously considered

The Adult at risk meeting will usually be chaired by a Manager or senior practitioner from the team responsible for the Enquiry. If several adults who are at risk are involved, a separate Adult at risk meeting may be considered for each person. Only one adult at risk should be present at any one time at an Adult at risk meeting.

Prior to the meeting any reports of the safeguarding assessment / enquiry should be accessible to the adult at risk concerned, with the involvement of a family member or advocate if appropriate.

Attendees should receive minutes for the part of the meeting they attended. Adult at risk meeting records and planning discussions must be entered on the electronic records system and copies faxed or be mailed securely to the parties involved within 5 working days.

Where an adult at risk does not have the mental capacity to be included, their representative or advocate must be nominated to take part in the review of the risk assessment and Adult at risk plan. The representative could be an advocate, key worker or relative.

Adult at Risk Meeting Conclusions

Any Adult at Risk or discussion should conclude with an adult at risk plan and be fully documented on the record of the discussion / meeting.

Key points for plans arising from planning discussions and meetings:

• identify action required to address immediate risk to the adult at risk concerned
• establish or review the adult at risk plan
• identify any specific coordinated action required in respect of the alleged person causing harm to minimise risks to the adult at risk who has been harmed, witnesses and whistle-blowers
• determine whether any internal press officer / department within organisations needs to be concerned to any possible media interest
• identify if further action is needed

Adult at Risk Plans

Where abuse appears to have taken place, or an ongoing risk is identified, an Adult at Risk Plan will be agreed to prevent possible further abuse or to decrease the risk.

The Adult at Risk Plan Must

• Include clear objectives and desired outcomes identified by the adult at risk concerned and practitioner leading the enquiry
• Specify the actions for individuals and agencies that have been identified
• Ensure that no tasks are assigned to an organisation or agency without confirming they are able and willing to carry out the role
• Show the required timescales for completion of all actions
• Include active consideration in consultation with the police and legal services, of the potential use of relevant legislation in cases where abuse has occurred
• Include consideration of referral to Witness Support Services of any adult at risk identified as entitled to ‘special measures’ under the police arrangements described in ‘Achieving Best Evidence’ such as an appropriate adult
• Include actions that may prevent the alleged perpetrator from abusing, maltreating or neglecting in the future
• Include any referrals for consideration under other multi-agency arrangements such as Multi Agency Risk Assessment Conference (MARAC), Multi-Agency Public Protection Arrangements (MAPPA) etc.
• Make arrangements for monitoring, support and counselling

Actions For Planning

Positive Actions to Prevent Repeat Abuse, or Neglect by a Person or an Organisation

The box below identifies a number of actions which may be used to reduce the risk of abuse re-occurring by management of the alleged person causing harm:

Actions to Promote the Safety of an Adult and for Recovery from Abuse, or Neglect

The list below identifies a number of actions which may be used to reduce the risk of abuse re-occurring by supporting the person with care and support needs:

• Activities that increase an adult at risk’s capacity to protect themselves
• Activities that increase health and wellbeing
• Victim support services
• Security measures, e.g. door locks and entry devices, personal alarms, telephone or pager, CCTV
• Support to give Best Evidence in Court
• Application to the Court of Protection for an appropriate person to make decisions on behalf of a person without relevant mental capacity
• Application to the Court of Protection for an appropriate person to manage the person’s finances
• Application for Criminal Injuries Compensation
• Supported decision making
• Advocacy and buddying
• Building resilience, confidence, assertiveness, self-esteem and respect
• Attachment based approaches
• Motivational interviewing and cycles of change
• Peer support, survivors networks, forums and circles of support
• Family and networks, including group conferences
• Brief interventions and Micro skills
• Mediation and conflict resolution
• Restorative justice
• Advocacy/ IMCA support services.
• New and/or increased support services to monitor actions agreed in the adult at risk plan
• Where proportionate and in the best interests or in accordance with the wishes of the person concerned, protection from contact with the alleged person causing harm, in the first instance by measures which remove the alleged person causing harm from the situation
• Counselling and therapeutic services
• Support or monitoring arrangements to others identified within the risk assessment that are in need of support
• Remember that the person with care and support needs should agree to the adult at risk plan and sign the plan to say that they have agreed
• Any additional support required for family and carers

Actions to be considered in relation to the person alleged to be causing harm include:

• Vulnerability of the alleged person causing harm
• Increase the observation of behaviours that are abusive and make interventions to prevent such behaviour
• Access to programmes supporting behaviour change
• Review of staffing levels, organisational procedures and culture of care
• Training needs assessment and supervision of staff and volunteers
• Change / increase the care provided to an individual to decrease carer stress
• Carry out a carer’s assessment and provide support and information to carers to improve the care they are able to offer
• Meeting with the alleged person causing harm (if appropriate) to feedback the results of the risk assessment and to negotiate changes on their part
• Change the service provided so that they are not in contact with a person/people that may pose risks of harm. If moving to another provider, assess the impacts upon the alleged person causing harm in terms of health and well being
• Where the alleged person causing harm is an employee or volunteer, consideration should be given to whether suspension is needed during the enquiry phase to ensure that people with care and support needs are safeguarded from further potential abuse and to protect the alleged person causing harm from further accusations. The decision to suspend must be taken by the employing organisation based on advice from police or investigating staff.
• HR or disciplinary proceedings, referral to professional regulatory bodies
• Prosecution by the court, CQC or a contracting authority
• Application for a court order such as a restraining order or injunction
• Civil remedies, e.g. suing the alleged person causing harm for damages caused to individual(s)

Review of the Adult at Risk Plan

The purpose of the review is to ensure that the actions agreed in the adult at risk plan have taken place and has been effective is addressing the outcomes identified by the adult.

A date for reviewing the plan should be set at the adult at risk meeting. The date must be determined by the needs of the case. Where there is an ongoing risk of abuse, reviews should take place at least monthly. If it is known that the Adult at Risk plan will need to be changed at a particular date (e.g. when the perpetrator is released from prison) then a date should be set to review the plan in time to make the changes necessary to protect the adult at risk.

The practitioner leading the enquiry has a responsibility to keep in touch with the person concerned (the adult at risk), which may be via face to face visits, phone calls or in writing, and ensure the support plan is updated with their involvement in accordance with presenting risks.

A review meeting can be reconvened earlier at the request of the person concerned and any agency involved in supporting them. The meeting should decide responsibility for ongoing management of the support plan (if needed) and whether or not to set a date for further review

Closure of the Case

The closure of a case can occur at any stage once the safeguarding risk assessment has been completed, if;

• The adult at risk concerned withdraws consent for the safeguarding enquiry to continue, has mental capacity to make the decision and there is no wider public interest;
• It is found that there is no or very low risk to the person or others, making it disproportionate to continue with a safeguarding enquiry and support needs can be met through other means.
• The enquiry has concluded and has achieved the objectives or outcomes set out in the adult at risk plan
• Where it is decided the enquiry can be closed, but some actions are outstanding these actions should be transferred to the Care & support plan or Care Programme Approach (CPA) care plan, and any other ongoing care plans

Records

Keeping Accurate Records of the Enquiry

It is important that clear and accurate records are kept on the electronic records system as they may be used as evidence in court proceedings.

Note that the report does not have to be long or complicated and should:

• Be written in Plain English
• Not include jargon or abbreviations
• Be easy to read
• Be understood by the person with care and support needs and their carer

It is good practice to prepare the report of the enquiry in draft for discussion, agreement and sign off at the adult at risk meeting.

Any agency involved in the assessment must ensure that this is clearly recorded on their agencies own recording systems.

A guide to what should be included in an enquiry report

• Name, address, date of birth, ethnicity of the adult at risk
• Details of next of kin and carers
• Allegation/suspicions reported – list each separately. If an allegation has been made, note who is making it; if a suspicion, the basis for it
• Record dates and locations where known
• Previous related allegations/history of abuse
• A brief description of the adult, including nature of support needs and communication needs
• Social situation/family network/carers and current services received
• Assessment of the adult at risk’s mental capacity relevant to any decisions that have to be made as part of the enquiry
• Views of the adult at risk who may be at risk and their expectations of the outcome
• Information about the person alleged to be responsible (if applicable)
• A description of the enquiry process and evidence gathered. Include information about the level of co-operation that you received from the various people involved
• Your assessment of the enquiry and analysis and rational for the outcome
• Risk assessment
• Determine on the balance of probabilities if the abuse occurred
• Recommendations for action and lessons learnt if appropriate
• Your name, organisation, team, position and qualifications
• Attach body maps, medical and other reports if appropriate to the case

Appendix Ten Multi-Agency Training and Resources Available

Virtual Briefings (short, animated power points with a narrative)

Virtual Briefings (sways) include:

• Making Safeguarding Personal
• Safeguarding Adults from Online Abuse
• Recognising Adults At Risk – Part 1
• Safeguarding Adults at Risk -Part 2
• Domestic Abuse and Safeguarding
• Sexual Violence and Safeguarding
• No Recourse to Public Funds
• Safeguarding for Community Volunteers

E-Learning during Covid-19 | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

Booking on to Virtual and Face to Face Training

Courses include :

• Termly Workshops on the Latest Safeguarding Messages and Lessons Learned from Safeguarding Adult Reviews and Audit Activity
• Self- Neglect and Safeguarding Adults At Risk
• Hoarding and safeguarding Adults at Risk
• Safeguarding adults and the Mental Capacity Act
• An Introduction to Domestic Abuse
• Domestic Abuse -Using DASH to Risk Assess the Situation

Multi-Agency Safeguarding Training | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)

Training Resources and Informative Briefings

Includes:

• Tool box and Power Point Slides for single agency training
• Briefings from Safeguarding Adult Reviews on the Lessons Learned
• Resource Packs
• Adult Safeguarding Glossary https://safeguardingcambspeterborough.org.uk/adults-board/glossary-of-safeguarding-adult-terms

Resources for Practitioners | Cambridgeshire and Peterborough Safeguarding Partnership Board (safeguardingcambspeterborough.org.uk)