Topic outline

  • 1. Making Enquiries, or Causing Enquiries to be made

    Local authorities must make enquiries, or cause others to do so, if they reasonably suspect an adult who meets the definition of an Adult at Risk (see The National Context, the Personalisation Agenda and Underlying Values and Principles) has needs for care and support, and is experiencing or at risk of abuse and neglect; and as a result of those care and support needs is unable to protect themselves from either risk of, or the experience of abuse or neglect.  

    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. The objectives of an enquiry into abuse and neglect are to:

    • Establish facts;
    • Ascertain the individual’s views and wishes and seek consent;
    • Assess the needs of the adult for protection, support and redress; and
    • Make decisions as to what follow-up action should be taken with regard to the person responsible, or the organisation, for the abuse or neglect.

    Making safeguarding personal means that safeguarding should be person led and outcome focused engaging people in determining how best to respond to their safeguarding situation. This involves a move away from process driven models of safeguarding. An enquiry can therefore be taken or instigated in a number of ways and should establish whether any further action needs to be taken to prevent or stop abuse or neglect and if so by whom. An enquiry could be:

    • Conversation/communication with the adult;
    • Contact with a representative or advocate;
    • Contact with a relative, service provider, professional;
    • A formal multi-agency meeting, plan or similar course of action;
    • A meeting of key individuals (formal and informal);
    • An action delegated to a partner agency in light of their expertise, involvement or any duty they may have to act.

    Central to the enquiry and what happens as a result of an enquiry should be the views of the adult concerned. 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 (see Advocacy in Safeguarding Procedure) to represent them for the purpose of facilitating their involvement.

    The focus of an enquiry must be on improving the adult’s wellbeing and all those involved in an enquiry should work together to achieve that aim.  This may include where appropriate consideration of other services that are available to Adults at Risk of abuse or neglect such as voluntary and community/charitable services.

    The scope of an enquiry, who leads and its nature, and how long it takes will depend upon the particular circumstances. The adult should always be involved from the beginning of the enquiry unless there are exceptional circumstances that increase the risk of abuse.

    The purpose of the enquiry is to decide whether or not the Local Authority or another organisation, or person, should do something to help and protect the adult. Where the Local Authority decide that another organisation should make the enquiry the Local Authority should be clear about timescales, the need to know the outcomes of the enquiry and what action will follow if this is not done.  An escalation process has been introduced so that any enquirers not responded to can be raised at an appropriate level within individual partner agencies.  The process is outlined in the Table (see Section 2 Stages in the Safeguarding Process).

    There are implications for all partners involved in safeguarding and not just the Local Authority. Local authorities must cooperate with each of their relevant partners, and those partners must cooperate with the Local Authority, in order to protect adults with care and support needs experiencing or at risk of abuse or neglect. Relevant partners of a Local Authority include any other Local Authority with which they agree it would be appropriate to cooperate (e.g. neighbouring councils with whom they provide joint shared services) and the following agencies or bodies who operate within the Local Authority’s area including (this list is not exhaustive):

    • NHS England;
    • Clinical Commissioning Groups;
    • NHS trusts and NHS Foundation Trusts;
    • Job centres;
    • The Police;
    • Prisons;
    • Probation services;
    • Local Authority functions;
    • Housing;
    • Service providers (independent, voluntary and private);
    • Department for Work & Pensions;
    • North East Ambulance Service;
    • Fire services.

    External agencies and partners who receive requests to make an enquiry will have a duty and/or moral responsibility to cooperate with the Local Authority.

    Professionals and other staff need to handle enquiries in a sensitive and skilled way to ensure distress to individuals is minimised. The Key Values and Principles of All Those Working with Adults at Risk (see point 5: Application of these Procedures on The National Context, the Personalisation Agenda and Underlying Values and Principles) should inform the ways in which professionals and other staff work with adults including when carrying out enquiries. The key principles apply to all sectors and settings. When requested to undertake enquiries this will need to be done when requested and within timescales. The Care Act 2014 requires that the Local Authority must make this clear.  They will need to report back any outcomes as requested. There may be a number of ways partners are contacted in order to make enquiries. The Local Authority is also required to know the outcomes of the enquiry.

    It is likely that many enquiries will require the input and supervision of a social worker. This will be the case in more complex situations, particularly where the dynamics or personal and family relationships are difficult to judge and rebalance, where abuse or neglect is suspected within a family or informal relationship and in supporting the adult to realise the outcomes they want to reach a resolution or recovery.

    Whilst work with adults may frequently require the input of a social worker, there are other aspects of enquiries which will be best undertaken by others with more appropriate skills and knowledge. Examples of this include health professionals for enquiries linked to treatment plans relating to medicines management or pressure sores or other areas of clinical practice; or housing officers, where the issues relate to the environment in which the person is living.

    External Agencies who undertake enquiries on behalf of the Local Authority must do so in an appropriate agreed timescale and should report the outcome of these enquiries to the Local Authority Safeguarding Adults Team, including any subsequent Safeguarding Plan (see 2.6) which has been agreed and implemented to protect/support the Adult at Risk.

    • 2. Stages in the Safeguarding Process

      There are 6 linked stages in the safeguarding process but it will not always be appropriate to go through these in an ordered sequence. A Table summarising what is included in the stages is available below.

      Stage 1Identification of a Safeguarding Concern issue(s)
      Stage 2Completion of the Safeguarding Adults Concern (SAC) Form and delivery to Safeguarding Adults Team
      Stage 3Fact Finding and Information Gathering process
      Stage 4Analysis of the Fact Finding and Information Gathering process
      Stage 5Agree Outcome Decision from the Fact Finding and Information Gathering process
      Stage 6Decision to close the Safeguarding Adults Concern or progress to further Safeguarding activity

      • 2.1 Initial Safeguarding Alert/Concern

        This is the first stage where a Concern is noted (see The Concern/the Decision to Refer Following an Initial Concern/Safeguarding Concern Procedure, The Concern). For the Local Authority the process of managing enquiries commences at stage 2 once they are alerted to abuse or neglect.

        • 2.2 Safeguarding Adult Concern (SAC) Form

          The Safeguarding Adults Team will coordinate the management of enquiries when a Safeguarding Adult Concern (SAC) Form has been received. This will involve information gathering where relevant to determine the most appropriate course of action for the circumstances. The adult’s views and wishes as they have been recorded or ascertained by the referrer, including any immediate action that has been taken and the reasons for those actions will determine what happens next. Any course of action will reflect the 6 key principles of the Care Act 2014: Key Principles of Safeguarding (see The National Context, the Personalisation Agenda and Underlying Values and Principles, Care Act 2014: Key Principles of Safeguarding).

          Once the Safeguarding Adult Concern (SAC) Form is received from a partner agency the Local Authority will record this. The Safeguarding Adults Threshold Risk Assessment  Guidance will have been applied by the Responsible Person or Safeguarding Adults Lead in the partner agency. In Sunderland this role has always been expected of partner agencies including commissioned services.  Although the statutory duty that was attached to some organisations no longer exists, the role that existed pre-Care Act 2014 is still required.  Responsibilities for application of the Safeguarding Adults Threshold Risk Assessment Guidance will be clearly reflected in Individual Agency Guidance (IAG).

          Where information has come directly from the public the Safeguarding Adults Team will either assume Responsible Person/Safeguarding Adults Lead role in respect of assessing the thresholds and completion of the Safeguarding Adult Concern Form information or ensure an appropriate professional is asked to do this.

          When determining any course of action following receipt of a concern, consideration is first given to whether the criteria for statutory safeguarding duties apply (see Definitions, Categories and Indicators of Abuse Procedure).

          Also considered are the following:

          • If a crime has been committed, has this been reported to the Police;
          • Have the Safeguarding Adults Threshold Risk Assessment Guidance been applied and reported;
          • Consent;
          • Other sources of information;
          • Circumstances of individual;
          • Identified outcomes as stated on the SAC Form;
          • The need to establish outcomes and who is best placed to establish these for particular circumstances;
          • Views and wishes of the individual named in the Safeguarding Adults Concern (SAC) (at all stages);
          • Actions already taken to safeguard (in line with Adult’s views and wishes);
          • Any additional actions required to safeguard;
          • Whether any other persons may be at risk;
          • The ‘whole family’ approach to consider any other individuals, Adults or Children who may be at risk of Abuse and whether further referrals have been or should be made;
          • The need for referral to the Sexual Assault Referral Centre (SARC) where there are concerns involving Rape or Sexual Assault (the Police will usually arrange this if they are undertaking an investigation) in all other cases professionals can make a direct referral to the SARC). * Where concerns relate to a non-accidental injury which do not include allegations of rape or sexual assault the need for an appropriate medical examination via either the persons GP, or Accident and Emergency services;
          • Where the safeguarding concerns relate to potential or alleged radicalisation a referral under PREVENT must be considered. Further advice on PREVENT can be sought from individual Agency PREVENT Leads (this is usually the individual Agency Safeguarding Lead, i.e. either the Organisation's Safeguarding Lead (or the Responsible Person), or the Local Authority Safeguarding Adults Team;
          • Adult (or alleged perpetrator) and need for social care assessment/capacity assessment;
          • Action linked to perpetrator;
          • Need for an advocate; including Local Authority commissioned advocacy service, voluntary/community/charitable services and Specialist Advocacy such as Independent Mental Capacity Advocates (IMCA’s) 
          • The most appropriate person to take actions or enquiries forward;
          • Level of detail provided and whether the referral is appropriate and is fully completed;
          • Potential conflicts of interest.

          Where it is determined that a formal Multi Agency Safeguarding meeting (see below point 3.1 Safeguarding Adults Meeting) is appropriate this will be coordinated and chaired by the Safeguarding Adults Team, who will also organise for formal minutes to be taken - this will not be the case where it is determined that actions/enquiries can or should be made via Multi-Disciplinary Team (MDT) meetings.

          • 2.3 Reviewing Safeguarding Adults Concern (SAC), Information Gathering and Outcome Information

            This stage will initially involve reviewing and evaluating the completed actions, enquiries and outcomes, any information and any other associated documentation linked to the safeguarding concern. At this stage evaluation should establish whether or not the outcomes have been achieved or whether the enquiry needs to continue. The Safeguarding Adults Enquiry will end if the following are achieved:

            • It is agreed that there is low level harm, and remedial or supportive actions have been taken;
            • Actions to manage the risk are clear and there are identified strategies to manage or reduce the risk;
            • The adult’s desired outcomes have been met as far as possible;
            • The adult’s desired outcome is not to apply safeguarding procedures and there are no other Adults at Risk, or wider public interest;
            • There is no additional information held to indicate a further concern/alert/pattern.

            In such cases where the SAC information gathering has ended, there may still be a continuing need for the ongoing involvement of agencies or services but this would not necessarily require management under the safeguarding procedures and therefore will be 'no further action'.

            Where an initial evaluation identifies that outcomes are not achieved and/or the adult is deemed to be at continuing risk of harm the S42 Enquiry should continue until it is considered appropriate to move to final evaluation stage.

            Where an Enquiry has ended consideration should be given to whether a Safeguarding Plan (see below point 2.6: Safeguarding Plan and Review Arrangements) is appropriate if not already in place. The Safeguarding Plan should incorporate any specific actions identified throughout the management of enquiries process which focus on the specific needs of the Adult at Risk and are considered necessary to the ongoing management of risk.

            At this stage if further information is identified or necessary the Local Authority may instigate a further S.42 enquiry as set out above in point 2.2: Safeguarding Adult Concern Form.

            If it is considered that the issues are particularly complex and/or there is professional disagreement, and/or non-compliance with action requirements then convening a safeguarding meeting should be considered. At any stage a safeguarding meeting can be arranged.

            • 2.4 Final Evaluation of Outcomes

              The final review of outcomes is the stages where all actions have been undertaken and enquires have concluded. There will be a need to agree the final outcome of any investigation or enquiries that have been carried out, confirm allegation(s) or otherwise, evaluate risk, establish whether outcomes have been achieved, including the Adult at Risk’s desired outcome, and whether risk has been reduced to an acceptable level.

              At this stage it will be necessary to establish whether there is a need for longer term safeguarding arrangements to be in place. This could include continued liaison with the adult and/or their representative and/or a long term safeguarding plan with clear professional responsibility and accountability. The safeguarding plan and any responsibility for monitoring and review will be agreed and clearly communicated to any Agency/Partner or individual who has been identified as responsible for the ongoing management, monitoring and or review arrangements.

              Any need for feedback should be agreed and the most appropriate person for the circumstances should be allocated the responsibility.

              Where a need for an additional summary is required or information confirming the position and responsibilities is required, this will be determined at this stage. This may be separate from a Safeguarding Plan. It may be that this is required but that a Safeguarding Plan is not.

              • 2.5 Safeguarding Plan and Review Arrangements

                A Safeguarding Plan and review could happen at any stage.

                Where a Safeguarding Plan is required a lead professional will be identified to coordinate this. This action may be identified as necessary through meetings or other communications.

                Responsibility of the lead will be to:

                • Ensure continued and appropriate involvement of relevant professionals/adult in respect of actions, roles and support;
                • Ensure Safeguarding Plan is known to all relevant organisations and applied in day-to-day work with individuals concerned;
                • Monitor and review the plan or ensure arrangements are in place to do so;
                • Supply first review date to Safeguarding Adults Team with information linked to whether outcomes continue to be achieved.

                Records should be kept by agencies. Where required, records should be supplied to the Local Authority.

                The Safeguarding Plan is for actions which directly manage the risk to the adult(s) concerned.

                One of the key aims of the Safeguarding Plan is to detail agreed actions to safeguard the individual, identify people responsible for carrying out the actions, timescales, monitoring and review arrangements. The Plan may identify (dependent upon circumstances individual to the situation):

                • The need for an assessment of mental capacity of the Adult(s) at Risk named in the SAC Form;
                • The need for further assessment of risk(s) and to whom;
                • The need to implement safeguarding strategies for the Adult at Risk and any others identified. This may include invoking certain procedures such as disciplinary procedures to suspend a member of staff;
                • The need to seek further information or clarification from other professionals;
                • The need to provide additional support, or fuller assessments by health and social care agencies (e.g. a needs assessment under the Care Act);
                • The need for Police involvement;
                • A plan to meet any needs arising from gender, sexuality, ethnicity or disability of any alleged victims, perpetrators or witnesses, including special measures in Achieving Best Evidence;
                • A plan to meet any needs arising from potential harassment or intimidation of any alleged victims, witnesses or ‘whistleblowers’ (see also Whistleblowing Procedure);
                • The need to coordinate between different strands of the assessment, for example any criminal or disciplinary action, or investigation of a complaint, so that they complement and inform each other, do not interfere with each other and do not result in any gaps;
                • An agreed communication strategy during the safeguarding process;
                • The appropriate method of feedback to the person(s) who submitted the SAC Form and who would be best placed to undertake this;
                • A way of ensuring ongoing communication with the adult(s) at risk and other concerned, including family members, and who will undertake this;
                • The need to agree a method to manage any media interest;
                • That there may be a need to separately consider the needs of an alleged perpetrator.

                The above are examples but each situation will be different.

                The Safeguarding Plan should adhere to the following principles:

                • The principles of ‘Making Safeguarding Personal’;
                • The first priority should always be to ensure the safety and wellbeing of the adult. The adult should experience the safeguarding process as empowering and supportive;
                • Action is planned to minimise risks to victims, witnesses and ‘whistleblowers’, and in appropriate circumstances the alleged perpetrator
                • Information is shared fully between participating agencies but is shared within the boundaries of confidentiality and with regard to the principles guiding information sharing (see Information Sharing and Confidentiality Agreement Procedure);
                • All actions should have agreed timescales for completion and be designated to named individuals;
                • Any actions identified are done so with the intention of minimal interruption to the services being provided to the individual, or a group of people, during the safeguarding process

                Review of the Safeguarding Plan – there should be an agreed and recorded timescale for the review of the effectiveness of the Safeguarding Plan. The first review should be within 6 weeks and monitored appropriately until case closure or outcomes have been achieved. There will be no need to continue with the safeguarding review process if the adult is no longer at risk or subject to ongoing risk, and if all outcomes have been confirmed.

                The Safeguarding Plan will also Include referral for consideration under MARAC (Multi-Agency Risk Assessment Conference) of any risk posed by perpetrators in cases of Domestic Abuse, MAPPA (Multi-agency Public Protection Arrangements) of any relevant alleged perpetrator meeting MAPPA, PREVENT for any individuals identified as being at risk of radicalisation or Potentially Dangerous Persons (PDP) criteria (see Multi-Agency Public Protection Arrangements (MAPPA) Procedure).

                • 3. Processes Supporting Management of Duties to Make Enquiries or Cause Enquiries to be made

                  There are a number of processes set out below which support the management of Enquiries and the Safeguarding Adult Concern process.  These processes are not an exhaustive list but do constitute the main forums within which referrals can be managed.

                  • 3.1 Safeguarding Meeting

                    In all cases the Local Authority Safeguarding Adults Team will need to consider how or whether the concern will be managed through formal meetings.  At any stage in dealing with a safeguarding concern if it is considered that the issues are so complex, or involve so many agencies, the a safeguarding meeting with formal minutes is considered the best way to proceed. In determining this there may be consultation with the referrer and relevant others to inform this decision. To avoid unnecessary duplication and to ensure management under the most appropriate process consideration will also be given as to whether a situation is already being dealt with via another method. This could include Multi-Disciplinary Team (MDT) meetings (see point 3.2, Multi-Disciplinary Team Meeting (MDT)), complex case reviews, and 3.3 Local Multi Agency Problem Solving meetings (LMAPS)), MARAC (see Domestic Violence and Safeguarding Adults, including Forced Marriage Procedure, Multi-Agency Risk Assessment Conference (MARAC)) and MAPPA (see Multi-Agency Public Protection Arrangements (MAPPA)), Missing, Sexually Exploited & Trafficked (MSET) meetings, to avoid duplication.

                    Where a safeguarding meeting is convened it will be chaired and coordinated by the Safeguarding Adults Team.

                    Where there are service-related enquiries, the Integrated Commissioning Team will be involved.

                    • 3.2 Multi-Disciplinary Team Meeting (MDT)

                      These meetings involve a number of professionals involved in providing care or support linked to an individual’s specific needs to ensure a coordinated response to providing for those needs. Multi-Disciplinary Team (MDT) meetings are different to Safeguarding meetings and can be used to address safeguarding issues but they are not chaired or coordinated by Safeguarding Adults Team.

                      Where a Safeguarding Adult Concern Form has been received in relation to an Adult at Risk who has needs which are already being managed using an MDT approach, the Safeguarding Adults Team may decide that it is appropriate to manage the enquiry using this existing forum.  Where there has not been an MDT and it is felt that the enquiry should be managed via an MDT the Safeguarding Adults Team will clearly set this out.

                      It may however be the case that despite attempts to manage the case via an MDT the safeguarding enquiry is still not effective.  In these instances it may be that a safeguarding meeting may achieve what the MDT has not been able to.

                      • 3.3 Local Multi Agency Problem Solving Groups (LMAPS)

                        Local Multi-Agency Problem-Solving groups are forums where complexities of individual cases are considered and agencies offer resources and support relevant to a situation or circumstances. Representation at these forums is from across disciplines and includes support and treatment services linked to drug and alcohol. They are particularly helpful in considering risk in terms of individuals and the wider community and especially so when individuals are both adults at risk and adults who are a risk to the wider community.

                        Where it is the case that a concern comes in for someone that is already active within existing multi-agency process it should not be necessary to convene an additional or duplicate multi-agency process. For consistency it is better to deal with matters in that forum with appropriate sharing of information. Each concern will be considered individually. Information will be shared and the LMAPS group will be requested to incorporate the issues raised in the referral rather than duplicate by convening another multi-agency process.

                        • 3.4 MAPPA

                          MAPPA (see Multi-Agency Public Protection Arrangements (MAPPA)) refers to the Multi-Agency Public Protection Arrangements. Representation at these forums is from across disciplines. Where appropriate and where the criteria are met adults will be referred to MAPPA. These meetings are particularly helpful in considering risk in terms of individuals and the wider community where offences have been committed.

                          Where it is the case that a Safeguarding Adult Concern Form is received for an Adult who is already within this multi-agency process it may be more appropriate for the concern to be taken to that forum. Each concern will be considered individually.

                          • 3.5 MARAC and Domestic Violence and Abuse

                            Where the Alert for the Adult at Risk concerns domestic violence and abuse, the Local Authority has specific considerations and responsibilities. Any concerns received will be reviewed in the context of these as set out below. Domestic abuse is a form of abuse covered by these multi-agency procedures.

                            Where there has been a disclosure about Domestic Violence/Abuse this may be the first and last time someone discloses or has the opportunity to do so. It is at this point that there is opportunity to signpost to appropriate support services, gain consent to refer, and establish what someone may want to happen and to safety plan. If the Adult at Risk has mental capacity to make relevant decisions and does not consent to a concern and there are no public or vital interest considerations they should be given information about where to get help if they change their mind or if the abuse or neglect continues and they subsequently want support to promote their safety. If the adult has current injuries as a direct result of Domestic Violence/Abuse they should be supported to access appropriate medical treatment, and or offered access to a medical examination so that the injuries can be examined and recorded. In all cases a record must be made of the concern, any views of the adult at risk and of the decision not to refer, with the reason stated. A record should also be made of information and advice provided and support they were given or offered.

                            The Responsible Person/Safeguarding Lead and professionals should decide in each individual case whether there is a need for referral to a Multi-Agency Risk Assessment Conference (MARAC) (see Domestic Violence and Safeguarding Adults, including Forced Marriage Procedure, Multi-Agency Risk Assessment Conference (MARAC)); The Risk Indicator Checklist (RIC) developed by SafeLives (formerly known as CAADA) should be completed in the presence of the victim/Adult at Risk and used wherever possible to assess the level of risk and whether the threshold for a referral to MARAC has been met. Further advice on referral in individual cases can be provided by the MARAC Coordinator.

                            Where the criteria for safeguarding has been met and the Adult at Risk has capacity and gives their consent then a Safeguarding Adult Concern (SAC) Form should be sent to the Local Authority clearly indicating the action that has been taken. This is in addition to MARAC where MARAC applies.

                            Where the Adult at Risk does not give consent the referrer must assure themselves that the decision to withhold consent has not been made under undue influence, coercion or intimidation. Any support or information provided must take account of the increased risk to people, and or individuals if the information and/or support provided is disclosed or made known to the perpetrator.

                            There are circumstances where a Safeguarding Adult Concern can be made to the Local Authority without consent. In these circumstances the Adult at Risk would normally be informed of the decision to refer and the reasons, unless telling them would further jeopardise their safety or the safety of others. Any rationale for decision making should be clearly recorded, by the referrer and the Local Authority.

                            If the Adult at Risk is assessed as not having mental capacity to make decisions about their own safety and to consent to a concern being made, a decision should be made in their best interests and in accordance with the provisions set out in the Mental Capacity Act (2005) (see Mental Capacity Act 2005 and Deprivation of Liberty Safeguards).

                            • 3.6 Safeguarding Adults & Integrated Commissioning

                              Where there are concerns raised that are linked to a health or social care service, inevitably there will be implications for other people. As with all other safeguarding concerns the Safeguarding Adults Team will decide how best to manage the concern. In some cases it may be more appropriate to take action to improve services through established commissioning processes or management arrangements.  These may include an investigation in relation to service standards, or organisational standards, contractual standards or regulatory standards and may apply even where the issues have come to light as a result of a safeguarding concern.

                              Where concerns received are linked to a service they will be risk assessed in terms of whether it is most appropriate to request the provider investigate, whether monitoring or investigation is via the quality function of the Integrated Commissioning Team (see Role and Involvement of Agencies Procedure, Safeguarding Adults Team and Integrated Commissioning Team) and/or whether another organisation has a role e.g. Clinical Commissioning Group, Health Watch, Care Quality Commission. Agreements on the way forward will be in accordance with business processes.

                              • 3.7 Sexual Exploitation, Sex Work and Missing Persons

                                Support services for adults giving consent are available and there are both strategic and operational groups to support safeguarding work with individuals including complex case reviews. Where concerns relate to these areas a concern may be managed via these resources. Each concern will be reviewed and decisions will be made as to what is most appropriate for the circumstances.

                                • 3.8 Financial Abuse Cases

                                  Cases of financial abuse need to be reported as a crime. Safeguarding Adult Concern Forms should identify that this has been done where a crime has been committed. Financial abuse and exploitation no longer have separate forums.

                                  See also Sunderland's Financial Abuse Guidance