What constitutes a safeguarding concern and how to carry out an enquiry

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This paper reports on two workshops and conversations aimed at building confidence in defining and working with safeguarding concerns and enquiries as well as improving understanding and building confidence more broadly.

Introduction

This is considered through the lens of two specific challenges presented by two regions. The aim is to support building confidence more broadly in safeguarding practice across partnerships.

The paper is part of the adult safeguarding workstream of Partners in Care and Health. This programme provides support to councils in England for social care, integration and health and digital improvement, as well as supporting the Transforming Care programme for people with learning disabilities and/or autism. It is a sector-led improvement programme co-produced and delivered by the Local Government Association (LGA) and the Association of Directors of Adult Social Services (ADASS), funded by the Department of Health and Social Care (DHSC).

A frequently asked questions paper is provided alongside this paper offering further support for developing understanding and confidence. This includes practical examples and tools shared by Safeguarding Adults Boards (SABs) and partner organisations to support development.

Frameworks

The work builds on the two frameworks (LGA/ADASS 2019; 2020). These are: 

These two frameworks are referred to throughout as the safeguarding concerns framework (LGA, 2020) and the safeguarding enquiries framework (LGA, 2019).

The process required regions or sub regions where these two frameworks have been adopted by the Safeguarding Adults Board and/or the local authority, to submit information about a particular challenge they had already been working on. Further engagement work explored why this matters, and what are the obstacles and opportunities for development and progress. (See appendix one).

Challenges

The two challenges are:

  • Differing perspectives on what constitutes a safeguarding concern (and the circumstances that indicate a safeguarding concern should be raised with the local authority) across health, the local authority, and the Safeguarding Adults Board. (Norfolk and Hertfordshire).
  • What is organisational abuse? How should this be responded to and reported? (North East region).

Addressing these challenges demands cultural change, complex solutions, and collective action at all levels as elements of these challenges are longstanding and significant. It isn’t realistic or possible to set out to ‘solve’ the challenges. What helps is breaking these challenges down into specific issues, defining and giving examples of achievable actions that can support commitment, improve understanding and gain progress.

For example, identifying what aspects of this challenge require a greater level of collective understanding? What actions can be taken locally, regionally or nationally that can help? How might this work support more effective outcomes for people? This activity can inform local and national action plans.

What emerged from this work was that leadership is needed at a national strategic level, joined up across sectors to support local and regional change.

Learning from safeguarding adult reviews (SARs) should drive commitment to change. Analysis of Safeguarding Adult Reviews: April 2017 - March 2019 reveals (LGA, 2020) that shortcomings across sectors in understanding responsibilities to raise concerns with the local authority and in the decision making about when to proceed to a safeguarding enquiry are prevalent when things go wrong. Examples of themes from SARs related to these challenges are set out as an appendix to the accompanying FAQ paper.

Specifically, they include:

  • uncertainty about safeguarding pathways
  • decisions not escalated or challenged
  • professionals not taking responsibility for raising safeguarding concerns (‘someone else will do this’)
  • lack of legal literacy in respect of S42 Care Act 2014
  • safeguarding concerns raised with, but not followed through by the local authority through an enquiry.

Seminal serious case reviews for example Orchid View (West Sussex Adults Safeguarding Board, 2014) and the Francis Reports (2010, 2013) into failures at Mid-Staffordshire hospitals highlight the key part that leadership must play in developing confidence in working with these challenges.  

Two regional workshops brought together partners across sectors to discuss challenges. Research, including wide ranging conversations and consideration of SAR findings, was undertaken to better understand the issues and challenges and identify approaches, tools and resources that can address the challenges.  

The work evidenced that conversations at every level across all sectors in partnerships are needed to develop confidence and consistency in how concerns and enquiries are progressed and undertaken. Dialogue and development activity is needed to draw on the available research and evidence base to inform conversations. Some aspects of the challenges can be impacted by a local focus and development. Others call for wider cross sector engagement at a regional or national level.

A recent report from the office of the chief social worker, Revisiting safeguarding practice (DHSC, March 2022), underlnes:

Safeguarding is ‘a collective responsibility working across multiple partners who can help address safeguarding concerns…It is vital for effective safeguarding that system partners and professionals work with one another to achieve the best outcome for individuals, considering their full set of needs and wishes. System partners may broadly cover different sectors that the individual needs support from such as the police, health, housing, justice, and leisure.'"

Summary of key messages

These key messages came from the regional conversations and research about what helps to build confidence in understanding what constitutes a safeguarding concern and carrying out safeguarding enquiries.

What can support confidence and consistency is:

  • Listening to the voice of people who may be in need of safeguarding support and their families and carers. Hearing people’s stories is a powerful tool to inform and motivate development, including those reflected in SARs. Seek out opportunities for engagement and consider the relevance of what is shared in informing how to work with safeguarding enquiries and concerns. Advocacy has a significant contribution to make here, both in practice and in informing local priorities for action.    
  • Leadership: All sector leaders working together including at national level, to support and develop confidence as well as to seek assurance. National protocols and guidance need to join up on these issues and be supportive of local progress. This includes leaders in the local authority, the NHS, Care Quality Commission (CQC), Police. Absence of sector leadership at national level on this issue, is experienced by some as hampering progress at local level.
  • Developing relationships across sectors: This involves a willingness to engage that is built on an understanding of the value this has for people, for organisations and because it’s part of everyone’s statutory responsibility. 
  • Engaging in challenging conversations: Through this, aiming for shared commitment and understanding at every level from front line practice to senior sector leaders. (Conversations have been at the centre of this work to build confidence).
  • Owning and discussing the barriers openly and honestly and making balanced decisions in light of what can be gained by working in this way.
  • Considering how the concerns and enquiries frameworks can support building confidence (including using the FAQ paper on concerns and the Quick Guides. (LGA, 2020)
  • Legal literacy: Each having a firm understanding of responsibilities and those of others. Not a loose translation of those duties and responsibilities or reference to only a selection of duties. This involves developing a common (post Care Act, 2014) language, regarding ‘enquiry’, ‘concern’, and so on.
  • Using the evidence base: What does it say? How is it relevant? How can it help? (Including learning relevant lessons from SARs. See appendix to FAQ paper).
  • Using and developing information and data that can support decisions about priorities and what needs to be addressed. Making best use of the national Safeguarding Adults Collection (SAC). Influencing and contributing to development of the SAC. Generating and using local information, including insights of people who need safeguarding support to supplement information in the SAC. (Some bespoke tables provided in relation to the challenges presented here have been provided by NHS Digital. These are referred to in the FAQ paper (within questions four and five) with some clarification).
  • Developing and using the frequently raised questions to decide jointly (across sectors) where a local focus needs to be. Which questions resonate most with local challenges? Working together on these.
  • Drawing on local approaches elsewhere that offer ideas for what works in developing solutions: The toolkit provided offers examples.  
  • Identifying what measures are already in place and what will be needed to demonstrate added value: Putting in place measures at the start and then keeping track of progress and development. Being aware of new issues coming to light that might generate new priorities. Having aims and objectives helps guard against effort petering out where challenges are complex.

Frequently asked questions

The following questions were prominent in the conversations and workshops that informed this paper. We suggest that these are used as a tool by SABs and sector leaders to identify where a local emphasis might be needed. The responses offer a basis from which to explore the issues and develop confidence and understanding. These questions and responses developed from the workshops (LGA, July 2022) are provided in a ‘frequently raised questions’ (FAQ) paper and can support local conversations. Included are examples of local approaches and tools that can help.

  1. Who does the Care Act apply to? Whose responsibility are safeguarding concerns?
  2. Is the safeguarding concerns framework a multiagency framework? To what extent Is the safeguarding enquiries framework multiagency?
  3. Given that safeguarding responsibilities are a partnership endeavour, what do we know about how far sector protocols and guidance link up and support consistent and shared practice? How far is safeguarding a partnership endeavour?
  4. What is a safeguarding concern and why raise a concern with the local authority? What difference can this make? Are some specific areas of concern treated differently.  What are the issues here?
  5. What is organisational abuse? What can help our understanding of this and can be reflected when raising a safeguarding concern? Why is it important to raise a safeguarding concern in relation to organisational abuse and/or to carry out a safeguarding enquiry under S42 Care Act, 2014?
  6. To what extent is it helpful or possible to precisely define terms such as ‘care and support needs’, ‘abuse and neglect’, ‘reasonable cause to suspect’? What needs to sit alongside definitions to support confident and consistent practice?

The significance of making safeguarding personal is highlighted within each question along with what can help support this and why it is important. Advocacy has an important role here. There is a particular focus on advocacy in response to question five in relation to organisational abuse. 

Proposed actions for cross sector leadership

This leadership was identified as crucial in taking necessary developments forward. It can both offer support and seek assurance to support effective working with safeguarding concerns and enquiries.

These proposed actions build on suggested key areas that were initially set out for review by Directors of Adult Social Services in the safeguarding enquiries framework (LGA, 2019) and reiterated in an ADASS advice note for Directors of Adult Social Services in July 2019. Here they are expanded to include key issues for all sector leaders and SABs to take forward in respect of both the safeguarding concerns and enquiries frameworks (LGA, 2019, 2020). This is a partnership endeavour. These are messages that the regional work (July 2022) reflected can offer necessary support to local action on developing confidence and consistency in working with the frameworks.

Key issues and actions for sector leaders

  • Seek assurance that decision making reflects statutory guidance and all relevant legislation, both in relation to raising of safeguarding concerns with the local authority and when the local authority undertakes safeguarding enquiries. Are the safeguarding concerns and enquiries frameworks (LGA, 2019, 2020) which reflect Care Act (2014) duties, used to support this? Is this assurance supported through commissioning assurance frameworks? Is it supported through SABs?
  • Ensure that the Care Act (2014) duties regarding concerns and enquiries responsibilities (reflected in the two frameworks, LGA 2019 and 2020) are integrated going forward in national sector guidance and protocols. In the meantime, put in place assurance processes (including through commissioning) to address existing inconsistencies and gaps.      

(Some examples of inconsistencies where a focus may be helpful are set out in the FAQ paper accompanying this paper).

  • Seek assurance on all pathways pursued when a safeguarding concern comes to light. Is the route taken to address presenting concerns, whether or not through a concern and / or an enquiry, effective in engaging with people to address the presenting issues? Where the statutory criteria for a S42 enquiry are not met, is alternative support such as advice, information, assessment of needs made available? Is partnership a hallmark of all these responses?

For leaders of organisations across SAB partnerships

  • Consider the impact of arrangements at the ‘front door’ of organisations, on decision making regarding safeguarding concerns and enquiries (see for example appendix 3 of the enquiries framework)
  • Develop and seek assurance that support and development opportunities for staff, managers and leaders are in place, in interpreting the legal framework and legal requirements (including statutory principles). Review how this is translated into and supported by practice and guidance.

For example: enable decision-making about concerns and enquiries under S42 Care Act (2014) to be a focus for reflective practice and case discussion. The workshops held in Yorkshire and the Humber as background to the enquiries framework and set out in appendix three of the framework are an example of this.       

Enable and support local and regional conversations to establish shared understanding and ownership of the frameworks for decision making (as in regional workshops (LGA, 2022)).

  • Check that local safeguarding adults procedures and other related protocols fully reflect the spirit of the Care Act (2014) and are not simply a reuse of old ‘No Secrets’ based, process-led ideas and approaches.
  • Pay attention to the language used about safeguarding. Language should convey the principles that are at the heart of good practice. Consider the suggestions in the framework for a shift in terminology away from terms such as ‘threshold’ or ‘three-point test’.
  • Seek assurance that practice is not driven by IT systems and reporting processes, that are designed on a linear flow of information. Decision-making is not a linear process in practice. Data needs to flow from practice rather than practice being driven by IT and reporting systems. Provide support and development to staff to guard against this. Engage in conversations with IT providers and NHS Digital to facilitate development of systems that support best practice.

SABs have a key leadership role

They can champion the frameworks and seek assurance of partnership engagement with them. This can include (in addition to a focus on some of the above):

    • Leading conversations across and within sectors about the value of raising a safeguarding concern. Increasing understanding and support for jointly addressing safeguarding concerns. Using the frequently raised questions highlighted in the work undertaken by LGA (2022) to identify where dialogue and action is particularly needed locally.
    • Promoting understanding of and use of the frameworks. Requiring assurance from partners that these are being used locally and that this achieves improvements in practice. Seek data and information to evidence this. Seek assurance that the frameworks are reflected in local protocols in partner organisations.
    • Contributing to and having oversight of development of pragmatic approaches to carrying out the S42 enquiry duty (this was raised as a particular issue in respect of health providers). Facilitating regular dialogue across sectors, confronting barriers to raising concerns and considering together the flexibility offered in the Care and Support Statutory Guidance (2022) for how S42 enquiries can be conducted. Recognising that where the three criteria in S42(1) are met, there is a duty to do so.
    • Considering how local information and data could supplement information available from the Safeguarding Adults Collection (SAC). This should include for example, audits, peer reviews, feedback from individuals who have received safeguarding support (or reflecting their experiences), feedback from conversations amongst practitioners. This will support broader assurance that people are safeguarded through prevention and early intervention as well as through statutory S42(2) enquiries. The MSP outcomes framework and examples of audit tools available will support this

A cross sector leadership focus at all levels on organisational abuse

This is a challenge at the heart of the work with regions (LGA, 2022). It can help, including through:

  • Offering support in defining and understanding organisational abuse (which as the workshops (LGA 2022) underlined can occur in all settings, including in peoples own homes. See question five FSQ paper). National level cross sector support is needed to achieve this clarity. Some examples in the accompanying FAQ paper help with this. The SAC guidance could offer support in defining organisational abuse as well as advice on when and how this should be reported in the SAC. 
  • Organisational abuse is a possibility in the whole range of provider services. There was some indication at workshops (LGA, July 2022) that it is more often considered in relation to care homes and nursing homes. A strong view was expressed that this should not be the case.
  • This clarity can help those raising concerns about organisational abuse to be clear about what the local authority will need to know. Some support for referrers already exists. Sharing this across regions and sectors will help.
  • Supporting clear and consistent messages about the duty to undertake S42 enquiries where organisational abuse is suspected. Steering away from development of parallel processes. Gain assurance that situations that constitute suspected organisational abuse and where S42 (1a-c) are met are addressed within S42 duties. In these instances, being clear that associated processes are part of deciding what action needs to be taken and by whom (rather than parallel processes instead of S42 duties ad not reported as such in the SAC). 

How will we know we are making progress?

How will we know we are making progress? Some ideas from two regions

It is not uncommon for effort to peter out when addressing complex multiagency issues. This will be less likely where clear short and long term objectives are identified. The two regions are considering achievable and measurable next steps. This may support others to plan objectives.

Both regions indicated the need for action at national level and had begun to connect with national bodies. Achievement of raising the profile of this challenge nationally is a shared objective and particularly gaining some traction with national sector leads to support addressing of inconsistencies across national protocols

Specifically on organisational abuse, which was integral to the challenge of both regions achievable objectives under discussion include:

  • developing local tools to support identification of organisational abuse and decision making in relation to this, drawing on local examples as well as those provided as part of the CHIP commissioned work (July 2022)
  • Agreeing a clear and unified definition and understanding of organisational abuse, including advice explaining what it is for those raising concerns with the local authority and those receiving them
  • evidence in protocols and practice of a shared understanding of organisational abuse, when and how to record and report this, reflected in information offered by the range of partners when organisational abuse concerns are raised with the local authority
  • more accurate reflection in the SAC returns of concerns and enquiries relating to organisational abuse.

Further objectives might include having local evidence in place (through collection of data and audits and other information) to demonstrate the nature of the local challenges and to provide clarity about where action is needed. For example, in the North East ‘undertake a regional organisational abuse data collection exercise for a specified time period in order to evidence the breadth of organisational abuse work and resource implications. In Hertfordshire it may be possible to audit safeguarding concerns raised, initially by a single NHS Trust to understand better what is happening in respect of health raising concerns and the local authority responses. To use this to inform next steps.

Dialogue is beginning to support understanding. A further shared objective is to support continuing focused dialogue, using the frequently raised questions and identifying measurable actions against the issues selected as priorities. For example, regular meetings between health providers and safeguarding professionals in the local authority, for some has led to greater confidence in understanding the circumstances in which a safeguarding concern should be raised with the local authority and why this can be positive. In Norfolk there is a plan to discuss development of routine discussions (initially with one health trust) of safeguarding concerns in line with S42 Care Act, 2014, (perhaps weekly or fortnightly). Evidence of the impact of this on confidence in working with concerns and enquiries will be used to inform broader practice and strategic discussions.

Dialogue is beginning to support understanding. A further shared objective is to support continuing focused dialogue, using the frequently raised questions and identifying measurable actions against the issues selected as priorities. A focus on feedback to people raising safeguarding concerns is one priority in Norfolk. Using the concerns and enquiries frameworks to evidence decision making will be part of this.   

Scheduled, regular meetings between health providers and safeguarding professionals in the local authority, has for some led to greater confidence in understanding the circumstances in which a safeguarding concern should be raised with the local authority and why this can be positive. In Norfolk there is a plan to discuss development of routine discussions (initially with one health trust) of safeguarding concerns in line with S42 Care Act, 2014, (perhaps weekly or fortnightly). Evidence of the impact of this on confidence in working with concerns and enquiries will be used to inform broader practice and strategic discussions.

Appendix one

It is not uncommon for effort to peter out when addressing complex multiagency issues. This will be less likely where clear short and long term objectives are identified. The two regions are considering achievable and measurable next steps. This may support others to plan objectives.

Both regions indicated the need for action at national level and had begun to connect with national bodies. Achievement of raising the profile of this challenge nationally is a shared objective and particularly gaining some traction with national sector leads to support addressing of inconsistencies across national protocols

Specifically on organisational abuse, which was integral to the challenge of both regions achievable objectives under discussion include:

  • Develop local tools to support identification of organisational abuse and decision making in relation to this, drawing on local examples as well as those provided as part of the CHIP commissioned work (July 2022)
  • Agree a clear and unified definition and understanding of organisational abuse. Including advice explaining what it is for those raising concerns with the local authority and those receiving them
  • Evidence in protocols and practice of a shared understanding of organisational abuse, when and how to record and report this. This is reflected in information offered by the range of partners when organisational abuse concerns are raised with the local authority
  • More accurate reflection in the SAC returns of concerns and enquiries relating to organisational abuse.

Further objectives might include having local evidence in place (through collection of data and audits and other information) to demonstrate the nature of the local challenges and to provide clarity about where action is needed. For example, in the North East ‘undertake a regional organisational abuse data collection exercise for a specified time period in order to evidence the breadth of organisational abuse work and resource implications. In Hertfordshire it may be possible to audit safeguarding concerns raised, initially by a single NHS Trust to understand better what is happening in respect of health raising concerns and the local authority responses. To use this to inform next steps.

Dialogue is beginning to support understanding. A further shared objective is to support continuing focused dialogue, using the frequently raised questions and identifying measurable actions against the issues selected as priorities. For example, regular meetings between health providers and safeguarding professionals in the local authority, for some has led to greater confidence in understanding the circumstances in which a safeguarding concern should be raised with the local authority and why this can be positive. In Norfolk there is a plan to discuss development of routine discussions (initially with one health trust) of safeguarding concerns in line with S42 Care Act, 2014, (perhaps weekly or fortnightly). Evidence of the impact of this on confidence in working with concerns and enquiries will be used to inform broader practice and strategic discussions.

Dialogue is beginning to support understanding. A further shared objective is to support continuing focused dialogue, using the frequently raised questions and identifying measurable actions against the issues selected as priorities. A focus on feedback to people raising safeguarding concerns is one priority in Norfolk. Using the concerns and enquiries frameworks to evidence decision making will be part of this.   

Scheduled, regular meetings between health providers and safeguarding professionals in the local authority, has for some led to greater confidence in understanding the circumstances in which a safeguarding concern should be raised with the local authority and why this can be positive. In Norfolk there is a plan to discuss development of routine discussions (initially with one health trust) of safeguarding concerns in line with S42 Care Act, 2014, (perhaps weekly or fortnightly). Evidence of the impact of this on confidence in working with concerns and enquiries will be used to inform broader practice and strategic discussions.