Research: Protecting adults at risk across council boundaries

Case study

Mrs B has dementia and receives support at home in a London borough. She goes to hospital in a different borough and, during her stay, she discloses to a nurse that she suspects a family friend is stealing money from her.

Mrs B’s daughter lives in a third borough but is very involved with her mother’s care. Mrs B tells the nurse that she does not want her daughter to know about this, because it will cause problems between her and the family friend.

Previously, there may have been confusion, misunderstandings and disputes about who is responsible for investigating and supporting Mrs B. Should the hospital deal with it? Should it be referred to the local authority in which Mrs B lives or the one where the hospital is? In which area should it be reported to the police? Should Mrs B’s wishes to not inform her daughter be respected?

Now, with new pan-London safeguarding policy and procedures in place, all staff across agencies can follow the same procedure and their responsibilities are clearly set out, so the process should be less time-consuming and more effective.

Introduction

Living a life that is free from harm and abuse is a fundamental right for everyone. Organisations and individuals working with adults who may be at risk of abuse need to improve the way they work together to protect people and investigate abuse and neglect, to avoid any inconsistency or confusion over who is responsible for what.

In London, local authorities, the police and NHS organisations have worked with the Social Care Institute for Excellence to produce multi-agency, sector-led policy and procedures on safeguarding adults at risk. Scie has published an at-a-glance briefing, which explains procedures to all frontline staff on preventing harm or abuse from occurring and responding to it when it happens.

Nick Ellender, who chairs the London Safeguarding Adults Network of local authority safeguarding leads, says you can achieve sector-led improvement so that all agencies have a common understanding of the principles and language that everyone uses. “We have always recognised, with partner agencies, the need for a consistent set of procedures and guidance across the 33 London boroughs,” he says. “The new multi-agency procedures represent the culmination of a lot of work and learning from each other’s good practice and contribution to safeguarding adults at risk. I believe this places partnership working on a better footing in London, and we will continue to develop and refine the procedures.”

Consistent policy and procedures

An adult at risk is someone who is 18 years old or over and may be in need of care due to a mental health problem, learning disability, physical disability, age or illness. As a result, they may find it difficult to protect themselves from abuse. There are many different types of abuse, including physical, sexual, emotional and psychological, institutional, discrimination, and financial and material. The challenge of keeping people safe and upholding their right to live free of harm and abuse requires organisations to communicate effectively. They also need to follow consistent procedures, while ensuring that the person is at the centre of the process and, wherever possible, in control of decision making.

The pan-London adult safeguarding procedures apply to all staff, including social workers, managers, other professionals and volunteers, working in public, voluntary and private sector organisations. Providers of social care services across London should all be working to these guidelines, which aim to make sure that the needs, interests and human rights of adults at risk are always respected and upheld.

The procedures say that a proportionate, timely, professional and ethical response should be made to any adult at risk who may be experiencing abuse. All decisions and actions have to be taken in line with the Mental Capacity Act (2005).

If you work with adults who may be at risk and someone tells you that they have experienced neglect or abuse, it is important to take steps to ensure their safety, listen carefully to what they are saying, stay calm and get a clear and factual picture of the situation.

Referrals to the relevant safeguarding adults referral point will be taken from anyone who has a concern that an adult is at risk.

Details of the relevant referral process should be readily available from the local authority. The referral may be passed to the local safeguarding adults team or allocated to a worker who will seek to clarify the circumstances of the alleged abuse or neglect.

The allocated worker will also decide if the safeguarding adult procedures are the appropriate response to the situation. They should call a multi-agency strategy meeting, to agree details of the investigation and who is responsible for each aspect of it. The person at risk should be involved, as much as possible, in decision-making at every stage.

Effective working across agencies

The London organisations that have worked together to agree the new policy and procedures believe that:

● Improved inter-agency working will prevent people from falling between the gaps in services.

● The procedures are necessary to reduce duplication of effort.

● There is a need to promote better understanding of safeguarding across all agencies.

● The same language and terminology should be used by everyone, to avoid misunderstandings and confusion.

This should help both commissioners and providers understand what is required.

Nick Ellender’s views on multi-agency procedures are echoed by DCI Sam Faulkner, from the Metropolitan Police Service’s public protection unit: “The Met is resolute in its commitment to improve services to adults at risk and will continue to work effectively with our partner agencies to achieve this.

“The pan-London policy and procedures provide overarching guidance on how we work as partners to safeguard adults in London who may find themselves at risk of being abused, neglected or exploited.”

Next steps

Each local safeguarding adults partnership in London is now asked to adopt the policy and procedures, so that there is consistency across the London area in how adults at risk are safeguarded from abuse. Some local partnerships may want to adapt various aspects to reflect particular local arrangements, but there is no need for them to produce their own policy and procedures from scratch.

Common training materials are being developed to make multi-agency training possible. Scie is working with the Association of Directors of Adult Social Services to develop similar regional policies and procedures in other parts of England, and will also publish a good practice guide in safeguarding early next year. This will be based on examples from across London.

Scie is also producing a film about safeguarding in care homes, which explores what managers and staff can do to safeguard residents from abuse, as well as what a good care home can do to respond to safeguarding concerns.

Key guidance messages

● The safety, needs and interests of adults at risk must always be upheld.

● Responses to any adult at risk who may be experiencing abuse should be proportionate, timely, professional and ethical.

● Agencies and individuals involved in safeguarding adults need to work together to protect adults at risk from abuse, investigate actual or suspected abuse and neglect, and support adults who experience abuse, neglect or exploitation.

● People should be empowered and supported to make their own choices, while being protected from harm.

Everyone with a duty of care to an adult at risk should:

● Act to protect the adult at risk.

● Deal with immediate needs, and ensure the person at risk is, as far as possible, central to the decision-making process.

● Report the abuse to the relevant local safeguarding adults referral point, which is usually the appropriate local authority adults’ services department.

● If a crime has been committed, or may have been committed, contact the police to discuss or report it.

● Record the events.

Further information

● SCIE (2011), At a Glance 44, Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse

● SCIE (2011), Report 39, Protecting adults at risk: London multi-agency policy and procedures to safeguard adults from abuse 

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