Safeguarding adults assurance information resource for directors of adult social services

The Department of Health and Social Care (DHSC) is working with the Care Quality Commission (CQC) to introduce an inspection/assurance regime for local authority adult social care services in 2023/24. Within this framework there is reference to safeguarding adults.

This resource aims to bring together some of the existing tools for audit, review and assurance to support sector led improvement in safeguarding adults. The new regime is based on statutory requirements in the Care and Support statutory guidance regarding safeguarding adults, and local authorities are the lead agency for safeguarding adults. Evidence of compliance with statutory requirements is essential for the director of adult social services (DASS) in this context. The Association of Directors of Adult Social Services (ADASS) Safeguarding Adults Policy Network, working with Care and Health Improvement Partnership (CHIP), the National Networks of Safeguarding Adults Boards Chairs and Managers, and the Principal Social Worker (PSW) network had collated resources provided to them used for audit, review and assurance. This has been built on to collect and collate tools that have been developed locally, regionally and nationally to produce an initial resource list.

The NHSE Safeguarding Adults network (SANN) have also contributed.

The London Voices network of People with Lived Experience has shared views on what is important to them; as has Think Local Act Personal (TLAP). This resource should be seen as an early start, and is not comprehensive, having been reliant on partners to submit relevant tools. The partner tools referenced do not imply particular endorsement and it is hoped further work and tools will be available and reviewed in September and when the final CQC framework is confirmed.

• The leadership role of the DASS for safeguarding involves a key role within the local Safeguarding Adults Board, working with the independent Chair or equivalent, although it does not mean responsibility for the partnership where the three statutory partners together have responsibility for assurance.
• This information resource includes tools auditing strategic safeguarding, partnership working, engagement with people with lived experience, strategic and policy development, statutory compliance front line safeguarding practice, and includes the work of Safeguarding Adults Boards.
• The resource provides a summary of tools provide, and a list of weblinks to the main host sites. The LGA has a wealth of materials, the SAB National Chairs website hosts the SAB national, regional and local tools that are sent to it. The ADASS website Safeguarding is closed to members only. The Social Care Institute for Excellence (SCIE) has many relevant materials and Research in Practice (RiP) now hosts a resource for PSWs in adult services. Its materials are restricted to paid subscribers and the PSW pages are password only.

Listed below are Care Act 2014 compliance tools, quality assurance audits for LGA/ADASS peer challenges, and tools from individual local authorities and SABs. Some cover themes of leadership, governance, culture, policies and procedures, commissioning, people, quality and monitoring, and Making Safeguarding Personal (MSP)/co-production.

Others link the six safeguarding principles:

• empowerment
• prevention
• protection
• proportionality
• partnership
• accountability.

Understanding how to assure MSP is embedded, with effective quality assurance and oversight is key for the DASS to be satisfied staff are carrying out procedures and properly and consistently.

Resources

There is a wealth of information provided on MSP on the LGA website, covering key areas a DASS would need to have assurance about and the MSP outcomes framework; as well as covering themes used by CQC and commissioners on 'safe, caring responsive and effective safeguarding arrangements'.

A commissioner/ provider table is provided on Resources to support Making Safeguarding Personal

A starting point for adult social care is both quantitative and qualitative with what happens with safeguarding concerns and conversion to enquiries. The NHS Digital Safeguarding Adults Collection (SAC) provides facilities for comparison on a range of safeguarding indicators on an annual basis.

For NHS Digital, go to Safeguarding Adults, England, 2020-21.

The Making Safeguarding Personal Outcomes framework report (May 2018) underlines the importance of including qualitative information in developing an understanding of the difference that safeguarding support makes for people. It offers support for developing audit questions and methodologies, including multi agency safeguarding case file audit and quality standards guidance on safeguarding audit provided by the LGA/ADASS.

The report refers to the significance of case file audit within this. Some examples of case file audit tools and guidance/methodologies are offered on Support for developing audit questions and methodologies. These have been shared by local authorities/Safeguarding Adults Boards where they might support others in developing audit methodologies.

Resources to support Making Safeguarding Personal

The MSP advice particularly mentions safeguarding concerns and enquiries work, as identifying actual or potential abuse/ enquiries is so fundamental. As is deciding through which pathway to address risks and through safeguarding enquiries (where these are the right pathway); deciding what action is to be taken and by whom. The advice can also be accessed here as well as the tools on working with risk that help with thinking about which pathway to pursue to address risk

The purpose of the framework developed on behalf of ADASS and LGA is to offer support in making decisions about whether or not a reported safeguarding adults concern requires a statutory enquiry under the Section 42 (S42) duty of the Care Act, 2014, safeguarded from abuse, neglect, and self-harm. To access LGA/ADASS work in concerns and enquiries and an FAQ please visit Safeguarding resources. 

It can also be accessed on Making Safeguarding Personal along with tools on working with risk that help with thinking about which pathway to pursue to address risk.

Quick guide to understanding what constitutes a safeguarding concern

Making decisions on the duty to carry out Safeguarding Adults enquiries

The Social Care Institute of Excellence (SCIE) provides analysis, information and advice tools on strategic as well as on professional practise both for single agency and multi agency audits. 

Guidelines on practise, Revisiting safeguarding practice, by the Chief Social Worker for England, even if not safeguarding specific, many principles of best practise and audit will apply.

The Revisiting Safeguarding Guidance states:

it is important that senior leaders use this document as part of a process to assure themselves of the quality and responsiveness of their adult safeguarding work. They should also check themselves against other like local authorities in the application of Section 42 and conversion of concerns to enquiries to ensure consistent application of the care act across England. This will require PSWs and DASSs across regions to work closely to develop parity of application"

Guidelines on Strengths-based approach: Practice Framework and Practice Handbook underlines ‘Strong leadership that supports and enables the change to occur, by behaving in a way aligned with the strengths-based practice themselves, is the best way to cultivate and reinforce a culture that is relationship based and strengths- based. Strong leadership will take actions that promote the importance of strengths-based ethos.

The PSW national group and resources are hosted by RIP assuring social work and professional practise developments, following priorities agreed with the Chief Social Worker for England. The DASS should consult with their PSW on the current tools that are available and accessible through PSW access to the detailed tools.

Safeguarding peer challenges

Peer reviews and peer challenges of safeguarding adult services in local authorities, can be conducted at a national level (through the LGA) or regionally (through regional ADASS) or individually (locally commissioned).

• Standards for Safeguarding Adults, November 2017
• Adult Social Care Peer Challenge: key areas of focus - additional probes, February 2015

For national standards: Adult Safeguarding Standards for Safeguarding Adults Boards 

Safeguarding Systemic audit tool and Quality Assurance Framework

Several local authorities have developed a Safeguarding Systemic audit tool and Quality Assurance Framework. Visit the ADASS website (DASS password-protected).

Social work quality assurance tool

North West ADASS region has developed a social work quality assurance tool along with an explanatory presentation, and benchmarking tool. The benchmarking tool is balanced between the BASW Ethical Framework Social Work and the TLAP "Making It Real" statements.

The rationale for designing this tool is to ensure we can benchmark whether our social work practitioners are delivering ‘Fit for Purpose’ and ‘Right First Time’ high quality social work services.

The purpose of the tool is to support organisations with defining what “good social work” looks like, how it can be measured, and how it can be improved. The tool has been designed to be used in conjunction with and to support organisations using local Social Work Quality Assurance and Practice Improvement frameworks.’

Social Work Quality Assurance benchmarking tool (May 2022). Visit the ADASS website (DASS password-protected).

Devon and Torbay Safeguarding Adults Board

A Safeguarding Multi-Agency Case Audit Protocol by the SAB

Worcestershire Quality Safeguarding Conversations

This tool has focus on social worker safeguarding conversations and learning. ‘This guide seeks to ensure that the conversations that we had with a person are quality ones, to help us reflect on our practice. Review and do more of what has been working. To explore options of how we might do things differently next time.’

Quality Safeguarding Conversation guidance

Oxfordshire Safeguarding Adults Board completed a joint process with the Children’s Board, incorporating the LGA Adult Safeguarding Improvement Tool and the Section 11 requirements of Working Together to Safeguard Children, including survey monkey practise questionnaire. The self-assessment is completed by board members and the practitioner questionnaire by frontline workers, allowing for triangulation of the information presented by board members. Both the children’s and adults board members come together for a peer challenge event where members are put into small groups of no more than four agencies. The groups will have received the self-assessment reports for the rest of their group and agencies take it in turns to ask questions of the other organisations based on the returns they have received and reviewed prior to the session. The agencies usually have 20 to 30 minutes of focus on one organisation in their group.

The Adult Board has an additional quality assurance process called the Supportive Learning Visit. This is a two and a half hour focused session on just one organisation and how safeguarding works within their organisation. They present to a group of peers from other organisations on how safeguarding works in their organisation, following through from an initial concern to them referring to external services. The peers are usually team manager level and every time these have been run at least one peer reviewer has fed back that they’ve learnt something new about the presenting organisation. It also offers a chance for some constructive challenge/scrutiny of the processes as well as the presenting organisation a chance to raise issues they have with multi-agency working in Oxfordshire. It’s taken from the model developed by the Hull SAB.

Copies of the self-assessment questions and the practitioner questionnaire can be obtained by contacting the safeguarding board: [email protected]

In some SABs, experience to date has been more on how individual agencies provide assurance to the board and come together for a check and challenge, now an increased focus on the actual arrangements for working as a partnership have been developed.

See the National SAB Survey 2022 published in June 2022

West Midlands ADASS region Care Act and Section 11 tool audit project

This project is a West Midlands Regional consortium involving 10 safeguarding partnerships (children and adults) to develop a single online audit platform for Care Act and Children Act Section 11 compliance. The intention is to maximise partner involvement and reduce duplication.They are working with an independent provider contracted to provide the technical element of the audit tool.

For enquiries, please email [email protected]

London SABs developed a Safeguarding Partnership Audit tool (SAPAT)

This is held by Brent SAB. For information email [email protected]

Solihull 2017-22 SSAB Quality Assurance Framework

Email [email protected]

Multi agency assurance tools

All the assurance tools listed below are multi agency, collated by SABs and can be found on the National Network for Chairs of Adult Safeguarding Boards website, and are typically used at challenge events for partners assurance, either multi or single agency. These resources are increasing as more SABs contribute and with new audit tools developed.

City and Hackney SAB (CHSAB) multi agency audit tools: The Board’s annual strategic plan for 2021/22 contains a section which directs that the Board will undertake a review of core safeguarding across the City and Hackney. Under this priority the Board identified that it will undertake a review of partners engagement with safeguarding training.

• City and Hackney Safeguarding Adults Board Partner Training Audit

All organisations which are contracting or subcontracting should, as a minimum, follow the below guidance on safeguarding adults. This should also be cascaded to any subcontracted organisations.

• City and Hackney Safeguarding Adults Board Making Safeguarding Personal
• Multi-Agency Case File Audit (MACFA) - Audit 2021: The MACFA is one of a range of mechanisms the City and Hackney Safeguarding Adults Board (CHSAB) seeks assurance that the outcomes and recommendations of the various Safeguarding Adults Reviews commissioned by the Board are working in practice. The theme of this year’s multi agency audit is self-neglect and safeguarding. This has been a theme in a number of local Safeguarding Adults Reviews, is increasing as a local safeguarding concern, and is particularly relevant due to COVID. The CHSAB recognises that the audit represents a small section of the work undertaken by agencies across City and Hackney. However, the process allows for a cross-agency approach to understand roles and responsibilities, identify good practice and areas for support and training. The audit relates to agencies and professionals that jointly work on a case, often having areas of cross-over, with each holding their own contemporaneous notes. In view of this, the audit tool seeks to focus on this inter-agency work. However, we recognise that some services do not easily fit into the normal audit process used by the Board. To support engagement in the process, the Board has created an audit tool that will be used by these agencies. We are asking that these agencies fill in a form for each case file that their organisation was involved in.
• MACFA short audit form 2020 V1 
• Multi agency Dementia audit tool : The criteria in this template have been selected to capture the experiences of adults with dementia and the evidence enables identification of the quality and impact of service for individual adults.
• Multi Agency Audit - Tool 
• Cornwall and Isles of Scilly Outcomes and Self-assessment template
• Merseyside SAB Item 6.0b Chapter14 Audit Tool April19
• West Midlands Care Act Compliance Audit for Safeguarding Adult Boards

Learning from SARs questionnaire

This has been developed to help the Safeguarding Adults Review Action Plan task and finish group understand the following: How widely SARs are being used; what learning has been implemented from SARs; how this has changed practice within your organisation; what impact have SARs had on your organisation; examples of how learning from SARs has been applied to safeguarding cases. This information will be used to identify how effective learning from SARs has been and also to create a series of good news and practice stories arising from SARs.

London Borough of Brent SAB

London Borough of Brent Safeguarding Peer Review Self-Assessment

Somerset SAB

The Somerset Safeguarding Adults Board’s Quality Assurance subgroup is keen to monitor the effectiveness of the Board as part of its performance and quality assurance framework arrangements, and to support the Board’s continuous improvement. All Board members are asked to complete the SAB Effectiveness Survey survey by to assist the subgroup in benchmarking current performance and in determining areas requiring further development. The statements within the survey reflect those outlined within the national Adult Safeguarding Improvement Tool, developed in partnership by the Association of Chief Police Officers, the Association of Directors of Adult Social Services, the Local Government Association, the NHS Confederation, and NHS Clinical Commissioners. The tool outlines the characteristics of well-performing and ambitious partnerships, and is recommended as a means of self-assessment as well as being used in peer reviews and challenge.

Newcastle SAB (NSAB) Partners Audit

Each partner agency to the Safeguarding Adults Board is asked to complete this self-assessment annually: Newcastle SAB (NSAB) Partners Audit. By completing the tool, agencies are: providing assurance to the SAB of their safeguarding adults arrangements; identifying areas for improvement; and providing examples of good practice. The Quality Assurance Framework is part of the annual cycle of audit, reflection and improvement for Safeguarding Adults Boards.

• NSAB Quality Assurance Framework  guidance
• NSAB Quality Assurance Framework template

The purpose of the SAB Manager Network SAB Assurance toolkit  is to enable and support the development of data sets and assurance tools including assurance frameworks and stories of difference as examples. This intelligence can inform emerging themes and priorities; and prompt a response from Partners. A key function of Safeguarding Adults Boards is seeking assurance and this toolkit may assist Board Managers and/or appropriate subgroups and/or business teams when considering what good assurance means locally. Sharing the right information, at the right time, with the right people, is fundamental to good practice in safeguarding adults but has been highlighted as a difficult area of practice

National Data Toolkit Framework has been created to provide guidelines to Safeguarding Adults Boards in relation to best practice working between Safeguarding Adults Boards and Safeguarding Children’s Partnerships. This document is primarily designed for Boards that work separately to their Children’s Safeguarding Partnership.

Checklist children and adults partnership working Oversight of Safeguarding Adults Board Partners

Engaging with people using services

Early work to help SABs on how to engage and involve people in partnership boards was done by Making Safeguarding Personal. It provides examples of how to achieve engagement, what to consider as no one size fits all. Here are some examples of how some SABs currently are developing engagement.

Ways in which to best engage with people using services, those with lived experience and carers varies according to different local approaches. These range from an emphasis on co-production to surveys using multi-media approaches and citizen- based approaches. Working with your local Health Watch on including safeguarding in themes and surveys can give a broader view too.

Making Safeguarding Personal: supporting increased involvement of services users

People with lived experience

As part of developing this resource, a few representatives of the developing London Safeguarding Voices group were asked about their experience of being involved in safeguarding audits or of what they thought was important to them. None had been involved in safeguarding audits ,although some were on SABs. One spoke positively of how on a first visit to a relative in a care home, she was texted to complete a small survey on what she thought about the home. The overwhelming view was to stress how important it was to be involved right at the start of developing any work, for co-production to be meaningful and not as an afterthought.

Resources to support Making Safeguarding Personal

Think Local Act Personal

A key organisation providing materials emphasising this, is Think Local Act Personal. (TLAP). They provide general resources, not safeguarding specific, on Co-Production Making it Real,Co-production ladder, and Co-Production tips are generic, although of potential application. 

• Think Local Act Personal: Making it real
• The Ladder of co-production (pdf)
• What is co-production? (pdf)
• The three Rs of social care reform (pdf)

Citizen-led approach

Some SABs follow a citizen-led approach, tapping into wider local authority involvement approaches and linking with local Healthwatch

See Leeds SAB Citizen-Led Guidance including Top Tips for Practitioners: Talk to me, hear my voice

Carers and safeguarding: a briefing for people who work with carers

Carers and safeguarding: a co-production. This is an update of the ADASS Advice note 'Carers and Safeguarding Adults' produced in 2011 for frontline workers and brings it in line with the Care Act 2014. It is intended to be used as a practical tool and does not seek to amend or replace existing statutory guidance that may be in place.

Carers and safeguarding: a briefing for people who work with carers will support the improvement in practice regarding safeguarding adults as well as safeguarding their carers. 

Other resources for safeguarding work with service users and carers are also available on the LGA and SCIE websites above.

SANN aims to provide a national voice to adult safeguarding leads representing clinical commissioning groups (CCGs) across England and acts as a clinical reference group to the National Safeguarding Steering Group (NSSG). In the context of integrated working and services including safeguarding assurance of a key statutory partner more information can be found through the NHS Safeguarding website.

The Safeguarding Assurance and Accountability Framework (SAAF), this document has been reviewed and updated and is currently going through NHS England and NHS Improvement (NHSEI) approval processes, the new document will reference the changing landscape across health and care of integrated care systems and integrated care partnerships. An infographic has been developed by NHS Safeguarding which outlines safeguarding assurance across the commissioning and provider health organisations and is included in the revised SAAF document. Therefore until the revised SAAF has been approved and launched the document below is current.

Safeguarding Children, Young People and Adults at Risk in the NHS: Safeguarding Accountability and Assurance Framework

The Safeguarding Adults National Network team has included a review/update to the safeguarding web page to their work plan and will be working with NHSEI web team to update information.

The most recent CQC partnership assurance framework review in 2018, Beyond Barriers, How older people move between health and social care in England, was a system review focused on the interface between health and social care, looking at the planning, commissioning and delivery of health and social care services. This provides an outline of a muti agency systems assurance approach. The evidence base looks at people’s experience, cases, surveys, focus groups and performance data to assess outcomes. This can read across to use these tools.

It states:

CQC reviewed 20 local health and care systems, to understand how services are working together to meet the needs of people who move between health and care services. Our focus was people aged over 65. In some areas, different parts of the system are working well together. In other areas, the system was less joined-up and not working as well for people. In the systems we reviewed, we found individual organisations working to meet the needs of their local populations. But we did not find that any had yet matured into joined-up, integrated systems. Health and care services can achieve better outcomes for people when they work together. Joint working is not always easy. The health and social care system is fragmented and organisations are not always encouraged or supported to collaborate. An effective system which supports older people to move between health and care services depends on having the right culture, capability and capacity. We have looked for effective system-working and found examples of the ingredients that are needed.’ Whilst safeguarding is not explicitly refenced the focus was on high quality pathways barriers and enablers to providing safe, timely high quality care."

The LGA National review of SARs 2017-19 provides briefings and key learning materials on their website. All SABs were asked to audit themselves against the findings and recommendations. How this has been done and ongoing ways of assuring learning is an area of development.

Analysis of Safeguarding Adult Reviews: April 2017 - March 2019

Many SABS have found effective use of seven minute briefings to pass on key messages to staff groups, with feedback to the SAB.

Recommendations may be single agency based who will want to use their own self assessment and monitoring tools for assurance.

All SARs are now being provided for the National Chairs SAR library on the National Chairs website.

Specific safeguarding areas for learning, emerging more from SABs, and SARs, and how to effectively use multi agency assurance tools are provided through the LGA/ADASS development materials and webinars on self neglect, homelessness and substance misuse.

Comments from partners on perceived gaps are summarised below.

Methods for improving the experiential aspect for people with lived experience and carers and assessing outcomes. Concern about ensuring the adequacy of support and resources with partners for multi agency SABs, the development of SAB assurance audits helps define this.

Clarifying existing tools that focus on key safeguarding themes: transitional safeguarding

The key area for more assurance tools cited by many partners involves transitional safeguarding for 18 to 25-year-olds and joint working with children’s’ partnerships on both multi agency basis as well as adult social care. RiP is leading work on transitional safeguarding which underlines the need for leadership across partners and promoting culture change to effect a new systemic approach. Developing assurance is part of this.

Learning from safeguarding adult reviews about Transitional Safeguarding: building an evidence base, Michael Preston-Shoot et al, Journal of Adult Protection

Access the National SAR library on National Chairs website using your local SAB Chair’s password.

Mental Capacity Act and Liberty Protection Safeguards

Work to follow is on the Mental Capacity Act and Liberty Protection Safeguards (LPS).

This is a programme of emerging safeguarding work that has synergy across the health and care safeguarding partnership. There is through the LGA/ADASS CHIP programme work on implementing new legislation and assurance both regionally and nationally. There are partnership connections relating to workforce training and ensuring consistent messaging across health and care staff a national minimum data set and working towards implementation of LPS.

This resource list selection is not exhaustive and subject to ongoing change with developments. The references here as stated are the beginning of developing a more comprehensive information resource, to be updated in September 2022 and when we have the final CQC Assurance framework and the safeguarding domains. We very much welcome feedback on whether this was of use, or not. And if you did use it how did it help, what are the gaps, and please let us have any tools that you have, that you think could be included and why. They must have a link to a website because documents change over time or arrangements being made for them to be placed on for example,the National Chairs website.

For comments by 1 September 2022, please send to [email protected]