Department of Health
Published: 16 May, 2014
guidance on adult safeguarding
Back to adult safeguarding
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The underlying princple of the Care Act should be the maintenance of autonomy. At every stage of assessment and/or intervention, the determining question should be, ‘Will/does this action enhance or detract from the individual’s autonomy?’
This principle should apply at all levels of provision and decision making, whether that is within the family, commissioning agents or service providers (both paid and unpaid).
The following answers are from Lambeth Safeguarding Adults Partnership Board.
14.122: this section would benefit from outlining how SARs link to other processes such as child death reviews and domestic homicide reviews. Can these processes be joined up?
There should be an expectation in the guidance that the recommendations of a SAR should be put in terms that are deliverable by the SAB that has commissioned the SAR.
Some partners felt that the new wording “safeguarding adults review” may give a diminished weight / importance to this process compared to the old wording “serious case review”
There is a need for Boards to be adequately financed, so the guidance should say that partner agencies must contribute to the Board’s resources.
There is a clear message that safeguarding is seen in its own right and not based on eligibility criteria. A collaborative partnership should harness this.
The Board should maintain a local ‘learning and improvement framework’ which is shared across local organisations who work with adults. This framework should enable organisations to be clear about their responsibilities, to learn from experience and improve services as a result.
The Board has a role in scrutinising performance information of all partner agencies and this should include performance in relation to DoLS and the use of the Mental Health Act.
The Boards Annual Report should be presented to the executive body of each agency represented.
The Board should maintain a local learning and improvement framework which is shared across local organisations who work with adults. This framework should enable organisations to be clear about their responsibilities, to learn from experience and improve services as a result.
There needs to be a focus on the SAB’s role in the prevention of abuse/neglect. SABs should have an overview of this for the area they cover.
Include a focus on self-neglect – including those with capacity who may not generally be in need of care/support but whose problematic use of alcohol/substances means they are likely to be frequent users of services, a risk to self and others and problematic in the community. In these instances, the individuals will often not engage until crisis point when they present in A&E or to police.
Death/serious harm as a result of self-neglect (where there is capacity) and refusal of services/support, meets the criteria for a Safeguarding Adults Review (we undertook one last year in these circumstances), and a paragraph outlining agencies’ joint responsibilities to remain in contact with these individuals and with each other in order to build trust and continue to provide support, would be useful.
There is a need to highlight the need for SAB’s to link to LSCBs, CSPs and HWBBs to ensure maximum impact.
More needed on accountability, links role and realtionship with HWB Board and realtionship with Council.
This response is submitted on behalf of the London Safeguarding Adults Network – the group of local authority safeguarding adults lead officers in London.
We would want the Guidance to say more about the relationship between the role of the SAB and aims found elsewhere in the Act
• Preventing the need for care and support (s2)
• Promoting integration (s3)
• Providing information and advice (s4)
• Promoting diversity and quality in provision (s5)
We would want the Guidance to say more about the options for governance of Safeguarding Adults Boards, in particular the relationships that there may be between SABs and
• Local authority governance such as whether a SAB should be incorporated in to the constitution of a local authority, and whether it might have a reporting line to a Corporate Committee, a Scrutiny Committee or somesuch
• Health and Well-being Boards: What functions do they have that relate to one another and how might they best work together?
• Community Safety Partnerships: How they may want to work together on shared issues such as domestic abuse, FGM, human trafficking, and risks of radicalisation where these relate to people with care and support needs
• LSCBs: What functions do they have that relate to one another and what is the scope for joint functions short of having joint Boards
The objective of a SAB is to ‘help and protect adults who have needs for care and support, who are experiencing or are at risk of abuse or neglect, and as a result of their needs are unable to protect themselves from abuse or neglect’. It may therefore be relevant to highlight the involvement of SABs in relation to the work carried out regarding the Mental Capacity Act and Deprivation of Liberty Safeguards. The principles of Safeguarding Adults and the issues relating to the unlawful deprivation of a person’s liberty are not mutually exclusive. The impact of the Supreme Court judgement regarding the ‘Cheshire West’ case has been significant and has placed this area of work under increased pressure and closer scrutiny. It could be beneficial to clearly articulate in the Care Act guidance notes the links between the responsibilities of the Safeguarding Adults Board and the regulation of the Mental Capacity Act/Deprivation of Liberty Safeguards activity at a local level.
The work of the SAB interweaves with the work of other strategic partnerships and there should be clear governance and accountabilities around all of these. Crime and disorder partnerships; health governance; LSCB and its work and partnerships etc. Sometimes it feels like the SAB is working in isolation with partners reporting unilaterally and not taking account of their partnerships and governance boards.
Yes. SAB’s should follow up their cases so as to learn from the outcomes of the decisions they have made in order to inform their decision making in the future. This learning should be mentioned in the SAB’s annual reports so that it may inform practice and tailor the training sessions.
Also 14.170 includes the national Assistance Act duties of protecting the person’s moveable property if the adult is being cared for away from home. The board should collect statistics on the implementation of this section so that there is evidence it is being implemented. And this duty should be referred to in the guidance in a clear manner.
Any reports written by the safe guarding board should be available to everyone/company mentioned in them so that they can be used to promote learning and improve standards.
Any service user who may face being moved as the result of an enquiry should have the option to remain where they are if they are found to be able to make a capacitous decision with respect to their place of residence.
Appeals processes should be clearly described in the guidance with flow charts and time frames.
In general terms we welcome the strengthening of Safeguarding Adults Boards and the greater clarity about their role and function. We remain concerned about the absence of a duty to co-operate, the absence of guidance on shared funding responsibilities and the increasing pressures on role and functions for Safeguarding Adults Boards at the time of major constraints in funding for all agencies around the Board table. The experience of major provider failures in the Safeguading Adults Boards areas has made us only too aware of the limitations on capacity across the partnerships and we are determined that safeguarding practices must significnatly improve through the vigilance of the Safeguarding Adults Boards.
We welcome teh clarity about the range of activities for Safeguarding Adults Boards. The aims as set out in paragraph 14.4 are helpful but bullet point 4 lacks clarity and it is unclear how any Board should discharge their responsibilities to achieve this aim. The South Tyneside Safeguarding Adults Board believes the consultation with Healthwatch is to be welcomed, and the guidance expresses the work of Boards in simple, easy to understand language.
We also welcome the inclusion of peer review, self-review and audit as key tasks for Safeguarding Adults Boards.
The guidance needs to mirror the LSCB guidance in Working Together 2013 in that it needs to be more prescriptive in terms of membership- only 3 organisations are shown as MUST- more need to be included in this category particularly adult social care providers.
The guidance makes no mention of budgets other than in a permissive tone in section 14.105 which is outlined in 3 brief sentences. LSAB’s cannot function on the goodwill or discretionary payments of its members.
Further clarification is required regardung the responsibilities of the board. “E.g. …… dealing with complaints, grievances and professional and administrative malpractice; Is that just in relation to alleged abuse or would there be an expectation to deal with guidance on handling of general complaints, grievances etc. where there are already a plethora of guidance, legislation and practice around these issues.
Governance on DOLs/MCA needs to be addressed at a local level depending upon the arrangements in place oversee this work. (In some local authorites, this is not a matter for SABs)
Mental Capacity Act (2205) and Deprivation of Liberty Safeguards as per House of Lords ruling.
Should include reference to advocacy arrangements and monitoring the impact of such work, reference to local implementation of ‘making safeguarding personal’ and other developing agendas as part of the work stream. Agree the accessibility of annual reports needs to be addressed, in order to increase public awareness make the format reader friendly and accessible in various formats and on appropriate websites. Additionally the SAB should report on emerging themes and approach relevant agencies to highlight these to raise awareness and work on prevention.
Additional aspects of the SAB’s work should highlight domestic abuse. The scenario given under 14.8 is one of domestic abuse however there is no reference to the dual process of involving domestic abuse agencies. The LGA and ADASS guidance is not reflected in the Care Act Guidance. Anger management is not recommended for domestic abuse and there is a danger that this could be misinterpreted as something for use in general in D.A situations.
The scenario under 14.70 is desciribed as a ‘domestic dispute’ – this was domestic abuse and is not showing a dual adult safeguarding and DA response. The response suggested would not be recommended by DA agencies as it could highten risk.
The scenario under 14.86 doesn’t promote the integrated DV and adult safeguarding response.
14.11 says domestic abuse between spouses – this should be phrased as partners/ex partners.
A prevention strategy should be part of core business of the SAB.
We believe including a template in the guidance would be overly prescriptive
However a fuller description of areas a SAB might include in their plan would be helpful. This description should include a much greater emphasis on prevention strategies. It should also include providing information (to the public and staff) and staff and service user/carer training
However, the emphasis should be on the SAB as a strategic body with it’s key function being assurance and accountability
In relation to governance para 14.121 should include the Board of the CCG (and any other statutory member)
Response to whistleblowing
Important to ensure the guidance does not become too cluttered with requirements & suggestions
Would it be useful to append a draft template for the strategic plan for SABs to use if they wish?
SAB’s should feed in to other prevention activities in their area eg. Work with families.
Themes from safeguarding enquiries and SARs should be shared with other agencies, boards etc
Education – so people understand abuse and neglect will not be tolerated. Links to schools would be helpful
Yes it would help as it will help benchmarking and ensuring greater consistency across different areas.
Boards need to be publicising what they have done in response to SCRs and SARs
If in a 2 tier area there needs to be recognition of the need to have local groups
Prevention needs to be spelt out as a must do for Boards
Education and training should be included because a competent workforce is essential
Record keeping and information governance should be added
Ensure Board’s Strategic Plan and associated actions are informed by local needs, data and local intelligence. Must address gaps.
Ensure communications are clear and appropriate eg. English as a second language, Braille issues
Whistleblowing in general needs to be addressed strongly in the regulations and to ensure support is available for the whistleblower.
Board’s should focus on competencies and training to ensure people understand the importance of whistleblowing
Yes, it would be helpful for consistency across authorities (group consensus)
There is no indication where the resources would be avaialable from to deliver SAB businesss. Clarity regarding funding is required.
Ensure that Safeguarding also applies to Carers. Recent experience shows that professionals see this only something that applies to disabled people/service users, yet Carers too can be vulnerable to abuse, discrimination, and so on, as well.
14.104 Facilitate guidance in response to dealing with complaints- what does this mean? Is it the function of the board to investigate and respond to complaints?
“Promote multi agency training” what does promote mean?
There is a need for the board to give formal direction and response to DoLs and Mental Act so this could be included.
SABs should report on the number of concerns that are reported to them, not just those which become a formal alert. Also report the number of days it took to formally level an alert, plus how long it took to resolve the alert.
Victims are waiting longer than necessary for situations to be resolved by other agencies, because agencies are waiting and having to chase for the reported concern to be leveled / resolved. Or waiting to get authorisation to deal with it themselves.
It would be helpful to amend sentence
The SAB should ensure that relevant partners provide training for their staff…..
this emphasises the agency responsibility to provide learning and development that is proportionate and relevant. This emphasis is necessary – particularly if LSAB are seen as being responsible for training – and it will eventually compromise the SAB role in challenge, review and accountability
It is felt that connections with other strategic boards should be emphasised as being important. Some further guidance about the formal linkages between Health and Wellbeing Boards would be particularly useful. Hate crime is mentioned a number of times in the Care and Support section of the Act and this area of abuse spans other boards such as Community Safety and Children.
The single agency role needs to be explicit in relation to quality assurance and safety of the workforce. There will be a conflict if SAB is perceived as the provider of training when they should have an oversight, review and audit role
Links with lscb can only be positive.
completely agree that there is a need to state single agency responsibilities-evidence to date is that they are assuming that multi-agency policies and procedures mean that it is not applicable. This is evident in workforce development and a ‘train me’ culture – with the LSAB providing training opportunities.
The independantly chaired safeguarding boards needs to adopt corporate responsability to safeguard their local communities. The partnership working should be genuine and meaningful.
Firstly LA’s need to be fair and follow their own policies and procedures & stop bullying care providers. I had two safeguarding alerts raised against my company one in July 2013 and one in March 2014 both brought by disgruntled staff that were dismissed and through CQC ‘s website.
Both are still open & I have been sent draft final reports but not attended any meetings and been refused to sight the evidence they state they have, all is based on hearsay! I have been going through the complaints process for a year now and the worst thing is the service users that wanted to stay were not given that choice. One of these ladies had her toe nail ripped out by the contracted provider and numerous other incidents of failed service but no action taken by LA or CQC ! They are all crooked, the real abusers are protected by LA’s and CQC because they have nowhere to move those clients to if they suspend the contracted provider. The whole system is in a mess it’s disgusting and I will keep fighting for my rights & my service users. Mr Lamb sort it out !
There is a need for clear guidance on the expectations of providers and the CCGS’S role with the Adult Safeguarding process and the Adult Safeguarding Boards. Currently there is little description of how this will work, if the details are not explicit, the Act will not be as effective.
There should be robust links between the SAB and the LSCB in order to ensure a co-ordinated aproach to the safeguarding agenda across the locality, for example, transitional care and the implementation of the MCA for 16-18year olds as applicable.
The close relationship between the Community Safety Board (including the Domestic Violence Agenda and reviews of Domestic Homicide)needs to be emphasized as these links can enhance the work of the Board.
there is a need to ensure that the LSAB and other roles supporting should be independent – and clarity of single agency responsibilities cannot be over emphasised.
there is a need to ensure that there is a coherence LSAB workforce strategy that will enable the board to incorporate a range of safeguarding priorities that are included as part of 14.163; 14.151; 14.161; and responsibilities for agencies have clarity
Health care providers often still use different thresholds from social care and can use a serious incident process and not the same safeguarding definition. This can cause problems for SABs nad LAs in monitoring and managing safeguarding across their area. It is welcome that the guidance gives greater powers to SABs and local authorities to call for investigations and monitor but can the guidance also provide for the same defintions and thresholds across health and social care.
Providers are often punished for raising safeguarding matters, where the abuser is in the household but it isnt taken further this often leads to a reprovision of services.
This could make providers less likely to report abuse they witness because of the financial costs to their business.
Providers should be protected, and the same for care staff who suffer a detriment when they lose work. Local Authority and NHS approaches to this are “the service user has choice”, even when they know they are being pressured by the person accused of safeguarding to change providers.
It means safeguarding is ineffective at all levels.
The safeguarding board should be able to question the court of protection in the event of objections to enduring power of attourney paperwork work going missing and which is then highlighted by the predicament of the person in care and their suffering -covered up by the home who in turn fool the social services because they are in cahoots with the attourney that the rest of the family objected to.
How will the SAB review work link with Domestic Homicide Reviews?
The provision of safeguarding adults training is on an adhoc basis by local authority safeguarding teams (usually) – this should be formally part of the SAB, or it maybe lost in funding cuts!
Plus some agencies don’t consider it (wrongly) as important as child safeguarding training.