5.3 Safeguarding Adults Boards

1. Introduction

Each local authority must set up a Safeguarding Adults Board (SAB). The main objective of a SAB is to assure itself that local safeguarding arrangements and partners are working well together to help and protect adults in its area who meet the criteria as in Section 2, The Safeguarding Duty, Adult Safeguarding.

The SAB has a strategic role and oversees and leads adult safeguarding across the locality, It has an interest in a range of matters that contribute to the prevention of abuse and neglect, including:

• oversees and leads adult safeguarding across the locality and will be interested in a range of matters that contribute to the prevention of abuse and neglect;
• the safety of patients in its local health services;
• the quality of local care and support services;
• the effectiveness of prisons and approved premises in safeguarding offenders;
• the awareness and responsiveness of further education services.

SABs need information on safeguarding in all providers of health and social care in its locality (not just those with whom its members commission or contract). It is important that SAB partners feel able to challenge each other and other organisations where it believes that their actions or inactions are increasing the risk of abuse or neglect. This will include commissioners, as well as providers of services.

The SAB can be an important source of advice and assistance, for example in helping others improve their safeguarding mechanisms. It is important that the SAB has effective links with other key partnerships in the locality and share relevant information and work plans.

2. Core Duties of the Safeguarding Adults Board

A SAB has three core duties:

• it must publish a strategic plan for each financial year that sets how it will meet its main objective and what the members will do to achieve this. The plan must be developed with local community involvement, and the SAB must consult the local Healthwatch organisation. The plan should be evidence based and make use of all available evidence and intelligence from partners to form and develop its plan;
• it must publish an annual report detailing what the SAB has done during the year to achieve its main objective and implement its strategic plan, and what each member has done to implement the strategy as well as detailing the findings of any safeguarding adults reviews and subsequent action;
• it must conduct any safeguarding adults review (see Section 5, Safeguarding Adults Reviews).

Safeguarding requires collaboration between partners in order to create a framework of inter-agency arrangements. Local authorities and their relevant partners must collaborate and work together as set out in the cooperation duties in the Care Act 2014 and, in doing so, must, where appropriate, also consider the wishes and feelings of the adult on whose behalf they are working.

Local authorities may cooperate with any other body they consider appropriate where it is relevant to their care and support functions. The lead agency with responsibility for coordinating adult safeguarding arrangements is the local authority, but all the members of the SAB should designate a lead officer. Other agencies should also consider the benefits of having a lead for adult safeguarding.

3. Provision of Local Adult Safeguarding Procedures

In order to respond appropriately where abuse or neglect may be taking place, anyone in contact with the adult, whether in a volunteer or paid role, must understand their own role and responsibility and have access to practical and legal guidance, advice and support. This will include understanding local inter-agency policies and procedures.

In any organisation, there should be adult safeguarding policies and procedures. These should reflect the Care and Support statutory guidance and the Decision Making Tree diagram 1B (see Section 4, Information Gathering, Responding to Safeguarding Concerns) and are for use locally to support the reduction or removal of safeguarding risks, as well as to secure any support to protect the adult and, where necessary, to help the adult recover and develop resilience. Such policies and procedures should assist those working with adults how to develop swift and personalised safeguarding responses and how to involve adults in this decision making. This, in turn, should encourage proportionate responses and improve outcomes for the people concerned. Procedures may include:

• a statement of purpose relating to promoting wellbeing, preventing harm and responding effectively if concerns are raised;
• a statement of roles and responsibility, authority and accountability sufficiently specific to ensure that all staff and volunteers understand their role and limitations
• a statement of the procedures for dealing with allegations of abuse, including those for dealing with emergencies by ensuring immediate safety, the processes for initially assessing abuse and neglect and deciding when intervention is appropriate, and the arrangements for reporting to the police, urgently when necessary;
• a full list of points of referral indicating how to access support and advice at all times, whether in normal working hours or outside them, with a comprehensive list of contact addresses and telephone numbers, including relevant national and local voluntary bodies;
• an indication of how to record allegations of abuse and neglect, any enquiry and all subsequent action;
• a list of sources of expert advice;
• a full description of channels of inter-agency communication and procedures for information sharing and for decision making;
• a list of all services which might offer access to support or redress;
• how professional disagreements are resolved especially with regard to whether decisions should be made, enquiries undertaken for example.

The SAB should keep policies and procedures under review and report on these in the annual report as necessary. Procedures should be updated to incorporate learning from published research, peer reviews, case law and lessons from recent cases and Safeguarding Adults Reviews. The procedures should also include the provisions of the law – criminal, civil and statutory – relevant to adult safeguarding. This should include local or agency specific information about obtaining legal advice and access to appropriate remedies.

The Care Act requires that each local authority must arrange for an independent advocate to represent and support an adult who is the subject of a safeguarding enquiry or Safeguarding Adult Review where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other suitable person to represent and support them (see Independent Advocacy).

4. Responding to Abuse and Neglect in a Regulated Care Setting

It is important that all partners are clear where responsibility lies where abuse or neglect is carried out by employees or in a regulated setting, such as a care home, hospital, or college. The first responsibility to act must be with the employing organisation as provider of the service. However, social workers or counsellors may need to be involved in order to support the adult to recover.

When an employer is aware of abuse or neglect in their organisation, then they are under a duty to correct this and protect the adult from harm as soon as possible and inform the local authority, CQC and ICB where the latter is the commissioner.

Where a local authority has reasonable cause to suspect that an adult may be experiencing or at risk of abuse or neglect, then it is still under a duty to make (or cause to be made) whatever enquiries it thinks necessary to decide what if any action needs to be taken and by whom. The local authority may be reassured by the employer’s response so that no further action is required. However, a local authority would have to satisfy itself that an employer’s response has been sufficient to deal with the safeguarding issue and, if not, to undertake any enquiry of its own and any appropriate follow up action (for example referral to CQC, professional regulators).

The employer should investigate any concern (and provide any additional support that the adult may need) unless there is compelling reason why it is inappropriate or unsafe to do this. For example, this could be a serious conflict of interest on the part of the employer, concerns having been raised about non-effective past enquiries or serious, multiple concerns, or a matter that requires investigation by the police.

An example of a conflict of interest where it is better for an external person to be appointed to investigate may be the case of a family run business where institutional abuse is alleged, or where the manager or owner of the service is implicated. The circumstances where an external person would be required should be agreed locally. All those carrying out such enquiries should have received appropriate training.

There should be a clear understanding between partners at a local level when other agencies such as the local authority, CQC or ICB need to be notified or involved and what role they have. The Association of Directors of Adult Social Services (ADASS), Care Quality Commission, Local Government Association, National Police Chiefs Council and NHS England have jointly produced a high level guide on these roles and responsibilities. The focus should be on promoting the wellbeing of those adults at risk.

Commissioners of care or other professionals should only use safeguarding procedures in a way that reflects the principles above not as a means of intimidating providers or families. Transparency, open mindedness and timeliness are important features of fair and effective safeguarding enquiries. CQC and commissioners have alternative means of raising standards of service, including support for staff training, contract compliance and, in the case of CQC; enforcement powers may be used.

Commissioners should encourage an open culture around safeguarding, working in partnership with providers to ensure the best outcome for the adult. A disciplinary investigation, and potentially a hearing, may result in the employer taking informal or formal measures which may include dismissal and possibly referral to the Disclosure and Barring Service (see Disclosure and Barring).

If someone is removed by being either dismissed or redeployed to a non-regulated activity, from their role providing regulated activity following a safeguarding incident, or a person leaves their role (resignation, retirement) to avoid a disciplinary hearing following a safeguarding incident and the employer/volunteer organisation feels they would have dismissed the person based on the information they hold, the regulated activity provider has a legal duty to refer to the Disclosure and Barring Service. If an agency or personnel supplier has provided the person, the legal duty sits with that agency. In circumstances where these actions are not undertaken then the local authority can make such a referral.

5. Safeguarding Adults Reviews

There are different types of Safeguarding Adult Review:

• SABs must arrange a Safeguarding Adults Reviews (SAR) when an adult in its area dies as a result of abuse or neglect, whether known or suspected, and there is concern that partner agencies could have worked more effectively to protect the adult;
• SABs must also arrange a SAR if an adult in its area has not died, but the SAB knows or suspects that the adult has experienced serious abuse or neglect. In the context of SARs, something can be considered serious abuse or neglect where:
  • the individual would have been likely to have died but for an intervention;
  • has suffered permanent harm;
  • has reduced capacity or quality of life (whether because of physical or psychological effects) as a result of the abuse or neglect;
• SABs are free to arrange for a SAR in any other situations involving an adult in its area with needs for care and support;
• SARs may also be used to explore examples of good practice where this is likely to identify lessons that can be applied to future cases.

The SAB should be primarily concerned with weighing up what type of ‘review’ process will promote effective learning and improvement action to prevent future deaths or serious harm occurring again. This may be where a case can provide useful insights into the way organisations are working together to prevent and reduce abuse and neglect of adults.

Early discussions need to take place with the adult, family and friends to agree how they wish to be involved. The adult who is the subject of any SAR need not have been in receipt of care and support services for the SAB to arrange a review in relation to them.

See Care and Support Statutory Guidance paragraphs 14.162-179 and local Safeguarding Adults Boards procedures for further information.

6. Providing Information

6.1 People with care and support needs and their carers

Information should be produced in a range of different ways, user friendly formats for people with care and support needs and their carers. Information should explain clearly:

• what abuse is;
• how to express concern;
• how to make a complaint;
• that their concerns or complaints will be taken seriously;
• that concerns will be dealt with independently;
• that they will be kept involved in the process to the degree that they wish to be;
• that they will receive help and support in taking action on their own behalf;
• that they can nominate an advocate or representative to speak and act on their behalf if they wish.

If an adult has no appropriate person to support them and has substantial difficulty in being involved in the local authority processes, they must be informed of their right to an independent advocate (see Independent Advocacy). Where appropriate local authorities should provide information on access to appropriate services such as how to obtain independent legal advice or counselling services for example. The involvement of adults at risk in developing such communication is sensible.

6.2 Commissioners, providers and other staff

All commissioners or providers of services in the public, voluntary or private sectors should disseminate information about the multi-agency policy and procedures.

Staff should be made aware through internal guidelines of what to do when they suspect or encounter abuse of adults in vulnerable situations.

This should be incorporated in staff manuals or handbooks detailing terms and conditions of appointment and other employment procedures so that individual staff members will be aware of their responsibilities in relation to safeguarding adults.

This information should emphasise that all those who express concern will be treated seriously and will receive a positive response from managers. Local roles and responsibilities

Roles and responsibilities should be clear and collaboration should take place at all the following levels:

• operational;
• supervisory line management;
• practice leadership;
• strategic leadership within the senior management team;
• corporate/cross authority;
• chief officers/chief executives;
• local authority members and local police and crime commissioners;
• commissioners;
• providers of services;
• voluntary organisations;
• regulated professionals.

6.2.1 Front line staff

Operational front line staff are responsible for identifying and responding to allegations of abuse and substandard practice. Staff at operational level need to share a common view of what types of behaviour may be abuse or neglect and what to do as an initial response to a suspicion or allegation that it is or has occurred. This includes GPs. It is employers’ and commissioners’ duty to set these out clearly and reinforce regularly.

It is not for front line staff to second guess the outcome of an enquiry in deciding whether or not to share their concerns. There should be effective and well publicised ways of escalating concerns if immediate line managers do not take action in response to the concern being raised.

Concerns about abuse or neglect must be reported whatever the source of harm is. It is imperative that poor or neglectful care is brought to the immediate attention of managers and responded to swiftly, including ensuring immediate safety and wellbeing of the adult. Where the source of abuse or neglect is a member of staff it is for the employer to take immediate action and record what they have done and why (similarly for volunteers and or students).

There should be clear arrangements in place about what each agency should contribute at this level. These will cover approaches to enquiries and subsequent courses of action. The local authority is responsible for ensuring effective coordination at this level.

6.2.2  Supervision

Skilful and knowledgeable supervision focused on outcomes for adults is critically important in safeguarding work. Managers have a central role in ensuring high standards of practice and that practitioners are properly equipped and supported. It is important to recognise that dealing with situations involving abuse and neglect can be stressful and distressing for staff and workplace support should be available.

Managers need to develop good working relationships with their counterparts in other agencies to improve cooperation locally and swiftly address any differences or difficulties that arise between front line staff or managers.

They should have access to legal advice when proposed interventions, such as the proposed stopping of contact between family members, or if it is unclear whether proposed serious and/or invasive medical treatment is likely to be in the best interests of the adult who lacks capacity to consent, require applications to the Court of Protection.

7. Senior Strategic Response

7.1 Practice leadership

All social workers undertaking work with adults should have access to a source of additional advice and guidance particularly in complex and contentious situations. Principal social workers are often well placed to perform this role or to ensure that appropriate practice supervision is available.

Principal social workers in the local authority are responsible for providing professional leadership for social work practice in their organisation and organisations undertaking statutory responsibilities on behalf of the local authority. Practice leaders / principal social workers should ensure that practice is in line with the Care and Support Statutory Guidance.

All providers of healthcare should have in place named professionals, who are a source of additional advice and support in complex and contentious cases within their organisation. There should be a designated professional lead in the Integrated Care Board (ICB), who is a source of advice and support to the governing body in relation to the safeguarding of individuals and is able to act as the lead in the management of complex cases.

All commissioners and providers of healthcare should ensure that staff have the necessary competences and that training in place to ensure that their staff are able to deliver the service in relation to the safeguarding of individuals. This is strengthened by the development of the Safeguarding Adults: Roles and Competences for Health Care Staff – Intercollegiate Document (RCN, 2015), which details the levels of training and competencies required for the different groups of staff in the organisations.

7.2 Strategic leadership within the senior management team

Each SAB member agency – local authority, Integrated Care Board (ICB) and police – should identify a senior manager to take a lead role in the organisational and in inter-agency arrangements, including the SAB. In order for the Board to be an effective decision making body providing leadership and accountability, members need to be sufficiently senior within their organisation and have the authority to commit the required resources and able to make strategic decisions. To achieve effective working relationships, based on trust and transparency, the members will need to understand the contexts and restraints within which their counterparts work.

All police forces in England and Wales have a head of public protection that has strategic management

7.3 Commissioners

Commissioners from the local authority, NHS and ICBs are all vital to promoting adult safeguarding. Commissioners have a responsibility to assure themselves of the quality and safety of the organisations they place contracts with and ensure that those contracts have explicit clauses that holds the providers to account for preventing and dealing promptly and appropriately with any example of abuse and neglect.

7.4 Providers of services

All service providers, including housing and housing support providers, should have clear operational policies and procedures that reflect the framework set by the SABs in consultation with them. This should include what circumstances would lead to the need to report outside their own chain of line management, including outside their organisation to the local authority. They need to share information with relevant partners such as the local authority even where they are taking action themselves. Providers should be informed of any allegation against them or their staff and treated with courtesy and openness at all times. It is of critical importance that allegations are handled sensitively and in a timely way both to stop any abuse and neglect but also to ensure a fair and transparent process. It is in no one’s interests to unnecessarily prolong enquiries. However some complex issues may take time to resolve.

8. Further Reading

8.1 Relevant chapters

Adult Safeguarding

Responding to Safeguarding Concerns

Information Sharing and Confidentiality

8.2 Relevant information

Chapter 14, Safeguarding, Care and Support Statutory Guidance (Department of Health and Social Care)