4.3 Responsibilities

4.3.1 Local Authority and NHS partnerships

Local Authorities can continue to enter into partnership arrangements with the NHS for the NHS to carry out a Local Authority’s ‘health-related functions’ (as defined in the 2000 Regulations the NHS Bodies and Local Authorities Partnership Arrangements Regulations 2000.)

In addition, by virtue of Regulation 4 of the 2000 Regulations , arrangements may only be entered into ‘if the partnership arrangements are likely to lead to an improvement in the way in which those functions are exercised’. The Local Authority would still remain legally responsible for how its functions (including adult safeguarding) are carried out via partnership arrangements.’ (Department of Health March 2015).

Work is underway in Berkshire to establish partnership arrangements between the NHS and Local Authorities. Refer to your local area team for further information.

4.3.2 Managers/Safeguarding Leads in all organisations

Every organisation will have a safeguarding manager or lead, although the specific roles and responsibilities will vary and they may not sit with one member of staff. Please refer to your local area for more information.

The role may include:

• Managerial support and direction to staff in that organisation.
• Decision making for concerns raised by members of staff and/or members of the public.

4.3.3 Safeguarding Adult Referral Points

Each organisation must have its own operational policy on how it manages adult safeguarding concerns, including a list of referral points with up-to-date contact details, so that staff and the public know how to report abuse and neglect. Referral points may be through a contact centre, specific access team or through a MASH or other locally agreed arrangements. The Local Authority is the main referral point even if others have their own, and all Local Authorities should provide referral points that are accessible outside normal working hours in order to respond to urgent concerns.

4.3.4 Professionals responsible for undertaking actions under adult safeguarding

Each Local Authority has professionals responsible for undertaking actions under adult safeguarding. In some instances there is a lead professional supported by other staff, where there are complex issues or additional skills and expertise required. The professional responsible will retain responsibility for undertaking and co-ordinating actions under Section 42 enquiries.

4.3.5 Safeguarding Manager

Safeguarding Manager is the member of staff who manages, makes decisions, provides guidance and has oversight of safeguarding concerns that are referred to the Local Authority, or through the NHS Trust where there are the above agreements in place.

The role will differ in each Local Authority but should be available for advice and consultation in complex cases. Refer to your area for more information.

A Best Practice Guide for the Decision-making role in Section 42 Safeguarding Adults Enquiries has been produced and can be found here.

4.3.6 Feedback

All adult safeguarding concerns referred to the Local Authority should be assessed to decide if the criteria for adult safeguarding are met. Keeping the person who raised the concern informed is an essential requirement under these policies and procedures. Feedback provides assurance that action has been taken whether under adult safeguarding or not. Organisations raising concerns may want to challenge or discuss decisions and need to be updated on what action has been taken. It is more likely that the public will continue to raise concerns, where there is an acknowledgement that their concern has reached the right agency and is being taken seriously. Feedback to the wider community needs to take account of confidentiality and requirements of the Data Protection Act 1998. ( See Information Governance Appendix Two).

4.3.7 Feedback to people alleged to have caused harm

The principles of natural justice must be applied, consistently with the overriding aim of safety and the requirements of the GDPR.

An evaluation should be carried out as to whether it is safe to share information about the complaint with the person allegedly responsible. If the adult at risk has capacity, their informed consent should be sought before sharing information with the person allegedly responsible. However, where the sharing of information to prevent harm is necessary, lack of consent to information sharing can be overridden. It may be a necessary part of a safeguarding enquiry to put information to the person allegedly responsible, where it has not been possible to obtain consent to this.

Providing information on the nature and outcomes of concerns to people alleged to have caused harm also needs to be seen in the wider context of prevention; for example, information can be used to support people to change or modify their behaviour. The person/organisation that is alleged to be responsible for abuse and/or neglect should be provided with sufficient information to enable them to understand what it is that they are alleged to have done or threatened to do that is wrong and to allow their view to be heard and considered. Whilst the safety of the adult remains paramount the right of reply should be offered where it is safe to do so. Decision making should take into consideration:

• The possibility that the referral may be malicious 
• The right to challenge and natural justice 
• Whether there are underlying issues for example employment disputes 
• Family conflict 
• Relationship dynamics 
• Whether it is safe to disclose particularly where there is domestic abuse 
• Compliance with the Mental Capacity Act 2005.

Feedback should be provided in a way that will not exacerbate the situation, or breach the Data Protection Act 1998.

If the matter is subject to police involvement, the police should always be consulted so criminal investigations are not compromised.

The Local Government Ombudsman and the Parliamentary and Health Ombudsman are both useful sources to explore case examples. The Information Commissioner provides advice on sharing information.

4.3.8 Dealing with repeat allegations

All concerns should be considered on their own merit. An adult who makes repeated allegations that have been investigated and decided to be unfounded should be treated without prejudice. Where there are patterns of similar concerns being raised by the same adult within a short time period, a risk assessment and risk management plan should be developed and a local process agreed for responding to further concerns of the same nature from the same adult. All organisations are responsible for recording and noting where there are such situations and may be asked to contribute to a multi-agency response. Information sharing to assess and analyse data is essential to ensure that adults are safeguarded and an appropriate response is made. Staff should also be mindful of public interest issues.

In considering how to respond to repeated concerns the following factors need to be considered:

• The safety of the adult at risk;
• Level of risk;
• Mental capacity of the adult at risk;
• Mental capacity and ability of the support networks of the adult at risk to raise the concern;
• Whether levels of support need to be increased to meet the outcomes of safeguarding concerns;
• Wishes of the adult at risk and impact of the concern on them;
• Impact on important relationships.

 4.3.9 Dispute resolution and escalation

Professional disagreements should be resolved at the earliest opportunity, ensuring that the safety and wellbeing of the adult at risk remains paramount. Challenges to decisions should be respectful and resolved through co-operation. Disagreements can arise in a number of areas and staff should always be prepared to review decisions and plans with an open mind. Assurance that the adult at risk is safe takes priority. Disagreements should be talked through and appropriate channels of communication established to avoid misinterpretation.

In the event that operational staff are unable to resolve matters, more senior managers should be consulted. Multi-agency network meetings may be a helpful way to explore issues with a view to improving practice. In exceptional circumstances or where it is likely that partnership protocols are needed the SAB should be informed.

In the case of care providers, unresolved disputes should be raised with the relevant managers leading on the concern and commissioners.

4.3.10 Cross-boundary and inter-authority adult safeguarding enquiries

Risks may be increased by complicated cross-boundary arrangements, and it may be dangerous and unproductive for organisations to delay action due to disagreements over responsibilities. The rule for managing safeguarding enquiries is that the Local Authority for the area where the abuse occurred has the responsibility to carry out the duties under Section 42 Care Act 2014, but there should be close liaison with the placing authority.

The ‘placing Local Authority’ continues to hold responsibility for commissioning and funding a placement. However, many people at risk live in residential settings outside the area of the placing authority. In addition, a safeguarding incident might occur during a short-term health or social care stay, or on a trip, requiring police action in that area or immediate steps to protect the person while they are in that area.

The initial lead in response to a safeguarding concern should always be taken by the Local Authority for the area where the incident occurred. This might include taking immediate action to ensure the safety of the person, or arranging an early discussion with the police when a criminal offence is suspected.

Further action should then be taken in line with Making Safeguarding Personal on the views of the adult, and the Care and Support statutory guidance on who is best placed to lead on an enquiry.

4.3.11 Timescales

 The adult safeguarding procedures do not set definitive timescales for each element of the process; however, suggested target timescales are included in the table below. In addition, individual local authorities or SABs may make decisions on timescales for their own performance monitoring. 

 Local guidance on timescales should reflect the ethos of Making Safeguarding Personal. It is important that timely action is taken, whilst respecting the principle that the views of the adult at risk are paramount. It is the responsibility of all agencies proactively to monitor concerns to ensure that drift does not prevent timely action and place people at further risk. Divergence from any target timescales may be justified where: 

• Adherence to the agreed timescales would jeopardise achieving the outcome that the adult at risk wants;
• It would not be in the best interests of the adult at risk;
• Significant changes in risk are identified that need to be addressed;
• Supported decision making may require an appropriate resource not immediately available;
• The adult’s physical, mental and/or emotional wellbeing may be temporarily compromised.

The timescales need to reflect:

• All other investigations such as NHS Serious Incidents (SI)
• The investigation that takes priority – this needs to be agreed on a case by case basis