1. Hampshire Safeguarding Adults Board Safeguarding Adult Lead Network

2. Programme 9.00 Arrival, registration and refreshments
9.15 Welcome and introduction
9.25 What’s changed in the Care Act 2014?
9.45 Update on the Multi-Agency Safeguarding Adults Policy
HSAB website demonstration
Trading Standards Safeguarding Team – Financial Abuse
11.00 Break
11.20 Managing allegations against people in a position of trust
11.50 Multi-Agency Risk Management Framework
12.20 Q&A
Networking, local professionals and resources
1.00 Close

3. National and local developments in adult safeguarding

4. Care Act (2014) statutory guidance
An amended version of the statutory guidance published by the DH on 10th March 2016.
Main change is the removal of the DASM role - replaced with requirement for allegations management policy re people in a position of trust
Some forms of abuse such as financial and domestic abuse have been expanded to reflect new legislation introduced since April 2015.
Revision tracker

5. What are we talking about?
Adult Abuse and Neglect
Domestic
Abuse
What are we talking about?
Physical
Sexual
Neglect
Psychological/
Emotional
Discriminatory
Financial
Sexual violence and exploitation
Modern day slavery
Scamming
Female genital mutilation
Mate Crime
Organisational
Hate Crime
Self neglect
Exploitation by radicalisers
Forced Marriage
Honour Based
Violence

6. 4LSAB Safeguarding Policy
Refresh of the 4LSAB multi-agency safeguarding policy in response to the changes to the Care Act statutory guidance.
Policy now updated - new information added re modern day slavery, Prevent, self neglect, risk management, scamming, domestic abuse and the management of allegations against people in a position of trust.
Available on the HSAB website as a web based resource
Website reviewed to make navigation easier – new section on guidance or providers

7. HSAB Website

10. HSAB safeguarding plan – key priorities going forward
Wide awareness of adult abuse and neglect and its impact - engaging local communities
Making Safeguarding Personal embedded across all sectors
Clear, effective governance processes in place across all organisations
Prevention and early intervention – promoting wellbeing, safety and acting before harm occurs
Learning from experience - mechanisms in place to learn from serious cases and improve practice and services
Well equipped workforce across all sectors

11. Sounding Board Survey
A survey of over 175 community and voluntary organisations
Fear of repercussions and reprisals
Fear of not being believed of becoming isolated or the loss of relationships.
Responses highlighted further work needed around raising awareness about adult abuse and neglect
A lack of confidence, pride, shame and embarrassment
2/3 had not seen leaflets or other publicity on adult abuse and were unsure of the reporting process
Enablers to reporting:
Barriers to reporting:
A more personalised approach and access to a trusted person
Not understanding the behaviour is
abusive
Greater support for informal carers and also victims of abuse
Fears of being seen as interfering or nosy
Access to advocacy, counselling services, support networks
Assumptions someone else will respond
Invest in rebuilding community spirit and caring for others.

13. HSAB Training Programme
Training event
27th April
8th June
21st July
16th Aug
28th Sept
12th Sept
30th Nov
7th Dec
Title
Safeguarding Adult Lead (SAL) Network event
Topic day Multi-Agency Risk Management
Topic day Making Safeguarding Personal
SAMA Network
Conference
Duration
½ day course
Full Day
½ day courses
Purpose
Annual event providing an update on national and local developments and a spotlight on key topics of interest
Introduction to the 4LSAB Risk Management Framework
Introduction to Making Safeguarding Personal
Annual update on developments and sharing of good practice re allegations management
Annual update on national and local developments and a spotlight on key topics of interest
Joint conference with the HSCB:
‘Think Family’
and Domestic Abuse
Target Audience
Operational safeguarding leads (all sectors)
Responders, decision makers, safeguarding specialists, managers
All staff (all sectors)
Partner agency SAMA leads
Venue
Kings Community Church, Cedar Hall, Upper Northam Road Hedge End Southampton SO304B7
Kings Community Church, Olive Room, Upper Northam Road Hedge End Southampton SO304B7
Fort Southwick, James Callaghan Drive, Portsmouth, Fareham
PO17 6AR
TBC

14. Safeguarding Adult Lead Network
Leads on safeguarding for their organisation.
Ensures concerns are logged and stored securely
First point of contact for staff for advice if they have concerns.
Knows the contact details of relevant statutory agencies e.g. adult services, Police, CCG, CQC, etc.
Assesses information relating to concerns about adults at risk.
Ensures the organisation’s safeguarding policy and related policies are kept up to date.
Decides if concerns should be notified to adult services 
Completes the Organisational Safeguarding Self Audit
Make safeguarding referrals.
Liaises with the relevant SAMA and LADO for their sector.
Annual update event

15. Resources to support providers
Care Act Implementation Checklist
Safeguarding Self Audit Tool
Safeguarding Learning and Development Strategy
Guidance on producing an internal safeguarding policy
Engaging Hampshire Communities resources
Alerter Checklist
Publicity material on abuse and neglect
HSAB Website
SAL Network
Risk Management Framework
Responding to Self Neglect and Persistent Welfare Concerns
Allegations Management

17. Risk Management Framework
Care and support organisations need processes to identify and respond to risks before concerns reach crisis point
Process can be initiated by any organisation when it feels the level of risk has become unmanageable
Effective risk management enabled by timely information sharing and targeted multi- agency intervention.
Triggers a multi-agency meeting to undertake a shared risk assessment and to develop a management plan.
A process for managing cases when there is a high level of risk but the circumstances may sit outside the s42 enquiry framework - but a multi-agency approach would be beneficial.
Can be aligned with single agency prevention, early intervention and risk management policies by adding a multi agency dimension.

18. Allegations Management
All organisations providing universal care and support services to adults with care and support needs must now have clear policies for dealing with allegations against people in positions of trust.
Employers must assess any potential risk to service users and, if necessary, to take action to safeguard those adults.
Policies must have clear recording and information-sharing guidance and timescales for action and reflect the need to preserve evidence.
Relates to current or historical allegations.
HSAB has developed an overarching Allegations Management Framework which should be reflected in internal policies.

19. Adult abuse and neglect – the extent of the problem?

20. Prevalence of adult abuse - 2015/16
Findings from the 2015/16 national safeguarding adults data:
Most common source of risk was someone known to the adult but not in a social care capacity (60%)
102,970 individuals with enquiries under Section 42 of the Care Act:
Social care support was the source of risk in 27% of referrals
60% were for females (61,985 enquiries)
In the remaining 13% of cases the source was someone not known to the adult.
63 per cent of individuals at risk were aged 65 or over (65,085 enquiries).
Location most frequently the home of the adult (43% or care home (36%)
Most common type of risk was neglect/AOO (34%) then physical abuse (26%) and financial (16%).
S42 enquiries by actions taken and outcomes: 25% no action taken, 67% action taken and risk reduced or removed and 8% risk remains
42% of the adults referred required physical support followed by support for LD (14%), MH (12%), memory & cognition (9%) and sensory (1%).

21. Safeguarding Adult Reviews
Under s44 of the Care Act 2014, SABs required to undertake a SAR when an adult has died or suffered serious harm.
In 2015/16, there were a total of 90 SARs (compared to 65 in and 60 in ).
SARs involved a total of 110 adults at risk, of which 57% suffered serious harm and died and 43%t suffered serious harm but survived.
A decrease in the no. of adults involved in SARs from 190 in but a larger proportion of died as a result of the abuse (57% compared to 30% in

22. Hampshire picture 2015/16
Overall safeguarding enquiries were 3324 ( an increase of 101 on the previous year) – involving 2,847 individuals
Older people accounted for 60% of the total referrals made. Clients aged 65 and under with a Physical Disability where the second most referred group accounting for 15%.
No. of enquiries relating to people with a learning disability dropped for the second consecutive year from 570 to 463 representing 14% of safeguarding enquiries .
Concerns about neglect and physical abuse were the most common reason for safeguarding referrals (41% and 23% respectively).
Most common location for the abuse or neglect was the adult’s own home followed by residential care.
One case met the criteria for a SAR – now been completed. A no. of other cases, fell short of criteria for a statutory review but these were subject to a multi agency review to gain learning.

23. Useful Links www.hampshiresab.org.uk www.skillsforcare.org.uk

24. Any comments or questions?

25. Financial Abuse
Adrian Ridley

26. Any comments or questions?

27. Multi-Agency Risk Management Framework

28. Overview
Multi-agency process for managing high risk, complex cases sitting outside statutory s42 enquiry process.
In complex cases, professionals are often dealing with long term and entrenched behaviours requiring a commitment to a longer term, solution-based approach with a focus on building trust and rapport .
Provides a collaborative, coordinated and multi-agency response to these ‘critical few’ cases ensuring:
Timely information sharing around risk;
Identification and holistic assessment of risk;
Development of shared risk management plans;
Shared decision making and responsibility;
Adult’s involvement and engagement in the process
Improved outcomes for the adult at risk.

29. Used when circumstances present an unmanageable level of risk to the organisation (not related to abuse or neglect by a 3rd party) e.g.:
On-going needs/behaviour leading to lifestyle choices placing them and/or others at risk;
Complex needs and behaviours leading the adult to cause harm to others;
Vulnerability factors place the adult at a higher risk of abuse or neglect including mate crime, network abuse, etc.;
‘Toxic Trio’ of domestic violence, mental health and substance misuse
Self neglect including hoarding and fire safety;
Risks previously addressed via a section 42 enquiry but for which the need for on-going risk management and monitoring has been identified.
Refusal or disengagement from care and support services;
Complex or diverse needs which either fall between, or span a number of agencies’ statutory responsibilities or eligibility criteria;

30. When is someone at risk?
An adult is considered to be ‘at risk’ when s/he is unable or unwilling to provide adequate care for him/herself and:
Is unable to obtain necessary care to meet their needs; and/or
Is unable to make reasonable or informed decisions because of their state of mental health or because they have a learning disability or an acquired brain injury; and/or
Is unable to protect themselves adequately against potential exploitation or abuse; and/or
Has refused essential services without which their health and safety needs cannot be met but do not have the insight to recognise this.

31. Capacity, consent and control
Adult’s right to make apparently unwise lifestyle choices and to refuse support should be respected.
Adult’s decisional and executive capacity to make a decision must be taken into account as well as their ability to understand and to manage in practice any risks and safety implications of the choice or decision being made.
Information and advice about how to minimise risks to be given to the person who (with capacity) has refused to accept support
Information also about how they can access reassessment in the future should they change their minds.
Decisions (either by the adult or the agency) should be kept under constant review

32. Process overview
Any agency can initiate the process – it takes the lead coordinating role with responsibility for convening and chairing the initial meeting.
Collaborative risk assessment may highlight circumstances or risks which would be more appropriately dealt with under another process and a referral should be made
Ensures timely information sharing between agencies – provides a holistic (multi-agency) overview of current risks and to develop a shared management plan.
Process continues until the identified risks are either resolved or managed to an acceptable level.
Any on-going support needed to maintain well-being and safety should be agreed before the case is referred back into the ‘business as usual’ process for any on-going work.
Adult should, as far as possible, be included and involved in the assessment process and in developing the risk management plan

33. Effective risk assessment
Up to date chronology (e.g. events and other factors which have increased risks)
Risk taking and risk management decisions being continually reviewed throughout
Clear analysis of risks to the adult, others people and the wider public
Clear monitoring and review arrangements
Analysis of the benefits and risks of both intervention and non-intervention
Regular review of the plan
Effective management oversight, support and supervision
Activity linked to care and support plans
Clear and accurate recording of decisions, actions and the rationale for these
A multi-disciplinary approach and involvement of a wide range of professionals
Active participation of the adult and focus on building support networks

34. Any comments or questions?

35. Allegations Management

36. Statutory Guidance March 2016
Removes DASM role - replaced by a new requirements on managing allegations against ‘people in positions of trust’.
Local agencies providing universal care and support services must have clear policies for dealing with allegations against people in positions of trust.
Reflect LSAB guidance
Clearly distinguish between an allegation, a concern about quality of care or practice and complaint.
Enable assessment of potential risks and actions needed to safeguard adults with care and support needs.
Includes clear recording and information-sharing guidance and timescales for action
Relates to current or historical allegation or concerns.

37. 4LSAB Allegations Management Guidance
An overarching framework setting standards around the management of allegations against people in a position of trust.
Supported by clear reporting requirements and arrangements across the whole system - this includes clear information-sharing arrangements and explicit timescales for action.
Individual member organisations are expected to develop its own business process detailing how it will implement this framework internally.
Ratified by all 4 SABs and replaces the joint DASM framework published in May 2015.

38. Underpinning principles
A proportionate, fair and transparent process building on current good practice and existing processes.
Each organisation responsible for taking action using their allegations management procedure
Clear reporting arrangements across the whole system built into contracts, commissioning arrangements, grant allocations, etc.
Timely, thorough action when concerns are raised with justifiable and proportionate information sharing
Well understood and managed interfaces with other processes(e.g. LADO, DBS, fitness to practice) and prompt referrals to relevant bodies
Clear recording of decisions and recommendations

39. Partner organisations responsibilities
Align (or develop) current allegations management processes in line with the standards set out in this framework.
Commissioners to use existing frameworks and processes to ensure allegations management and safe working procedures are in place within the organisations from whom they commission services.
Providers to adhere to reporting requirements and promptly share information about relevant incidents with their commissioners.
Statutory organisations to nominate a Safeguarding Allegations Management Advisor (SAMA)
Non statutory organisations to nominate a Safeguarding Adult Lead (SAL)
Each LSAB is responsible for leading development work in its area to support this

40. Effective governance
SPOC for allegations or concerns raised by other agencies
Gaining assurance that appropriate systems are in place to demonstrate:
Ensuring managers appropriately identify and manage risks
- Effective risk assessment
- Safeguarding actions carried out
Management oversight of individual complex cases.
- Support/update the employee
- Recording provides an audit trail
- Prompt DBS/FTP referrals
‘Managing Concerns Meetings’ to assess and determine actions required.
- DPA/Confidentiality compliance
Maintaining records of the no. and nature of allegations and using this data to inform service improvement
Information sharing with statutory agency SAMAs and LADOs.

41. Interface with s42 enquiries
Any concerns relating to a person in a position of trust who is alleged to have abused an adult with care and support needs must be reported and responded under the Hampshire Multi-Agency Safeguarding Adults Policy and Guidance.
These concerns could arise from the person’s home / personal life, as well as within their work.
Includes anyone working with adults with care and support needs such as paid or unpaid employees, volunteers, students and personal assistants

42. Circumstances relevant to s42 enquiries
A ‘person in a position of trust’ has or is alleged to have abused an adult with care and support needs
A ‘person in a position of trust’ has behaved (or is alleged to have behaved) towards another adult in a way that indicates that they may pose a risk of harm to an adult with care and support needs
Includes situations involving an investigation into a criminal offence, even if the victim of that offence was not a person with care and support needs
A ‘person in a position of trust’ has behaved (or is alleged to have behaved) towards children in a way which means they could pose a risk of harm to adults with care and support needs.

43. Allegations management in the context of s42 enquiries
Where a formal safeguarding enquiry is being undertaken, the allegations management can be overseen within the enquiry process:
Assessment and management of risk posed by a ‘person in a position of trust’ to be considered in the initial safeguarding planning meeting and subsequent meetings
Any action taken in respect of a person to be included in the safeguarding enquiry report
Supporting documentation should be reviewed as part of the Checking and Review stage of the safeguarding enquiry
Further actions to safeguard should be included in the safeguarding plan

44. Allegations management outside formal safeguarding enquiries
Where a formal safeguarding enquiry is not being undertaken, a ‘Managing Concerns Meeting’ should be held to assess and determine the actions required to manage the risk posed by a ‘person in a position of trust’.
Such meetings may need to include commissioning, contracts, police, CQC, LADO and other relevant parties, where appropriate to the case

45. Information sharing
Managers must be informed if there are concerns about an employee during the course of their work.
If concerns arise in the person’s personal or private life, or in another work setting, the decision to share information must be justifiable and proportionate and based on the potential or actual harm to adults at risk.
Rationale for a decision to share information should be recorded.
Information sharing decisions based on:
‘Has the person has behaved/may have behaved, in a way that questions their suitability to undertake their current role or to support adults with care and support needs”?

46. Considerations when deciding to share information
Nature and seriousness of the actions/behaviour
Nature of the person’s access/role with adults at risk
The context within which the actions/behaviour occurred
Potential impact on an adult with care and support needs
Frequency or patterns of actions/behaviour

47. Employer risk assessment and management process
Risk management arrangements are the responsibility of the manager - these should take into account their assessment of the risk, internal policies and procedures, and employment law.
Only the manager has the power to suspend an employee, redeploy them or make other changes to their working arrangements, and so must be responsible and accountable for the decision reached.
The organisation’s allegations management policy should be followed.

48. Review of working arrangements (1)
The manager is responsible for assessing and managing the risk of harm posed by the person – should take account of:
- nature and seriousness of the allegation
- harm to any patients/service users
- risk of repeated incidents/on-going behaviour.
Suspension may need to be considered - this shouldn’t happen automatically but only if the circumstances of the case warrant a person being suspended until the allegation is resolved.
Where it’s been decided NOT to suspend, this should be informed a risk assessment
The manager should also make arrangements to keep the individual informed about developments in the workplace.

49. Review of working arrangements (2)
Suspension may not be required if risks can be managed through changes to working arrangements such as:
Not working with a particular patient/service user
Working in a non-patient/service user contact role whilst the allegations are being investigated.
If a person is suspended, they are entitled to know in broad terms the reasons for this and to be afforded the right to respond (but at the appropriate time).
Care should be taken to ensure information is not shared at the point of suspension that may prejudice a subsequent enquiry/investigation or place any person at additional risk.

50. Grounds for suspension
Suspension should be considered in any case where there is cause to think:
An adult with care and support needs is at further risk of abuse or neglect, or
The allegation warrants investigation by the Police, or
Is so serious that it might be grounds for dismissal, or
The presence of the person in the work place will interfere with the enquiry/ investigation process

51. Support for the person
Alongside the duty of care towards the adult at risk, is the duty of care to the employee.
The employer need to provide support to minimise stress associated with the process, this may need to include:
Support for them to understand the procedures being followed
Updates on developments
Opportunity to respond to allegations/concerns
Support to raise questions or concerns about their circumstances.

52. Monitoring information
The organisation should:
Maintain appropriate records of cases in line with the Data Protection Act 1998 requirements and individual organisational policies around information governance and record retention.
Establish systems to enable allegations against staff to be tracked across the organisation.
Collate/analyse information about the number and nature of allegations made and their outcomes
Produce an annual report to be shared with relevant boards, committees and leadership teams to inform on-going service improvement and development.

53. Any comments or questions?