Safeguarding Discussions and Meetings

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

These are:

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

See: Overarching Aims, Duties and Principles Procedure.

Strengths based approach

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

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

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

Adopting a strengths based approach involves:

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

Good information and Advice and Prevention

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

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

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

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

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

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

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

See: The Skilled Conversation

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

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

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

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

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

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

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

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

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

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

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

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

A strategy discussion is a professional conversation between the local authority Safeguarding Adults Coordinator (SAC) and the lead practitioner.

An initial strategy discussion should take place as soon after the decision to move to enquiry has been made. This may or may not take the form of a physical meeting.

Subsequent strategy discussions should take place as required throughout the safeguarding process, to update the SAC about progress of enquiries, to address any issues or barriers or to discuss any new information or changes in risk that may indicate a change of response is needed.

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

Actions to complete

1. Allocate a lead practitioner;
2. Establish the need for a planning meeting;
3. If a planning meeting is needed, agree a date/time for the meeting;
4. Answer the questions below; and
5. Discuss the points below.

The lead practitioner may be a local authority social worker, but depending on the circumstances of the case, could also be a professional from another agency for example a nurse. Allocation decisions should take into account:

1. The skills, knowledge and experience of the worker in carrying out safeguarding enquiries;
2. The skills, knowledge and experience of the worker in working with the particular needs of the person (for example health needs or communication needs); and
3. The views and wishes of the person themselves in relation to the skills required of the worker and who they feel would best support them.

Note: When a decision is made to hold a planning meeting this must be scheduled to take place no more than 5 days after the date that the referral decision was made.

Questions to be asked

If the police are already investigating

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

As such, the lead practitioner must contact the investigating officer to discuss the actions proposed during the initial strategy discussion, to take advice on the appropriateness of those actions and to invite the investigating officer to be part of the planning meeting.

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

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

Risk to others

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

For example:

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

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

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

How to report concerns about a child

Professionals must use the online reporting form to raise a concern about a child. 

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

Further strategy discussions should take place as and when required as the enquiry progresses:

1. Have there been any issues gathering the information?
2. Is everything on track to provide the information as agreed?
3. Is there any new information relevant to the concerns?
4. Is there a need to arrange an unscheduled planning meeting?

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

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

Where an initial planning meeting is to take place this must be scheduled no more than 5 days after the date that the referral decision was made.

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

The lead practitioner is responsible for organising any planning or review meetings.

This includes:

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

See Section 3: Involving the Adult in Safeguarding Discussions and Meetings

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

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

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

It may also be necessary to arrange for administrative support (a minute taker) if the circumstances are complex and a large number of professionals or organisations will be providing information and views.

Police

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

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

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

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

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

If concerns are about a service provider

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

The lead practitioner should discuss the appropriateness of the service provider themselves being invited with the Safeguarding Adults Coordinator (SAC) and the Commissioning Manager. A decision may be made to exclude them or to invite a representative from their Head Office instead.

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

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

Health and Safety related concerns

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

Requests from the adult to involve others

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

The person alleged to have caused harm

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

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

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

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

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

Planning and review meetings should be chaired by the local authority Safeguarding Adults Coordinator (SAC).

Note: If the SAC is not available, they should designate an appropriate colleague to deputise in their absence.

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

In all cases the following must be discussed:

For guidance on all of the following see: Undertaking a Section 42 Enquiry Procedure

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

Where urgent or immediate action is needed to manage, reduce or remove risk to the adult an interim Safeguarding Plan should be developed as part of the planning meeting.

See: The Safeguarding Plan Procedure.

If an interim Safeguarding Plan has already been developed this should be reviewed as part of the planning meeting.

Review meetings may be scheduled (planned as part of an agreed review process) or unscheduled (in response to new information or a change in circumstances).

The professionals and agencies involved in the initial safeguarding planning meeting should be involved in any subsequent review meetings unless there has been a change in circumstances and their involvement is no longer relevant.

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

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

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

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

Have enquiry objectives been met?

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

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

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

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

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

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

Developing a Safeguarding Plan

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

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

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

See: The Safeguarding Plan Procedure

Closing the case

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

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

See: Closing a Safeguarding Case Procedure

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

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

This could include:

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

Recovery and resilience

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

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

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

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

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

It is the responsibility of the local authority Safeguarding Adults Coordinator (SAC) to monitor that referrals/notifications have been made by relevant partner agencies.

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

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