Large Scale Enquiry Policy and Procedure

Large Scale Enquiry Policy and Procedure

Adults’ Health and Care Department Procedure: / 08/16 v2.1
Large Scale Enquiries
Date: / 01/05/2018
Effective Date: / 01/04/2017
Summary: / This document outlines the approach to be taken by
Hampshire County Council, Adults’ Health and Care, when considering the Large Scale Enquiry process as an appropriate safeguarding response to concerns in provider settings.
Issued By: / Care Governance Board
Contact: / Nila Murday – Safeguarding, Quality and Governance Consultant
Sponsor: / Jo Lappin - Head of Safeguarding, Quality and Governance
Authority to Vary: / Departmental Management Team
Care Governance Board
Procedures cancelled or amended: / Large Scale Enquiries 08/16 v2.0
Version Control:
Amendment: / Date:
Formatting / 01/05/2018
YOU SHOULD ENSURE THAT:-

• You read, understand and, where appropriate, act on this information
• All people in your workplace who need to know see this procedure
• This document is properly filed in a place to which all staff members in your workplace have access

Purpose

The purpose of the Large Scale Safeguarding Enquiry (LSE) policy is to outline the processes required to undertake an LSE in a proportionate way and when it is appropriate to consider the LSE process as a safeguarding response. The Large Scale Enquiry (LSE) policy should be read in conjunction with the Hampshire and Isle of Wight Multi Agency Safeguarding Adults Policy, Guidance and Toolkit (2015).

Scope

This policy covers all providers who undertake regulated activities (domiciliary, residential and nursing care) within the Hampshire County Council area or where commissioned for Hampshire residents out of the Hampshire area. The policy applies to providers in an NHS regulated setting or a social care regulated setting. This includes settings where all services are commissioned by a health based commissioner, for example: hospital; GP.

For the purpose of responding to safeguarding concerns, Adults’ Health and Care will also respond to organisational abuse in unregulated services, for example, day service settings and housing providers and as such this Policy also covers such enquiries and as with all LSE close partnership working within and between agencies is essential.

Large scale abuse in the community involving multiple victims such as situations of sexual exploitation, forced marriage, human trafficking, where the Section 42 duty is triggered, require close partnership working between the Police, Adults’ Health and Care and other partner agencies. However these large scale investigations are more likely to be led by the Police under other procedures, i.e. major incidents, major investigations, cross border or international investigations etc.

In the majority of large scale enquiries, the major concerns are symptomatic of care quality issues or are regulatory in nature. Typically, large scale enquiries have identified issues of leadership, lack of supervision, poor care and support planning, risk assessment and risk management, staffing, clinical care (e.g. pressure ulcers), communication, financial management, environmental factors, selection and assessment and compatibility of service users, staff training, infection control, medication and poor moving and handling. The cumulative effects of the above poor practice are often contributing factors to neglect and abuse.

The Care Act Guidance is clear and states that “safeguarding is not a substitute for:

providers’ responsibilities to provide safe and high quality care and support;

commissioners regularly assuring themselves of the safety and effectiveness of commissioned services;

the Care Quality Commission (CQC) ensuring that regulated providers comply with the fundamental standards of care or by taking enforcement action; and the core dutiesof the police to prevent and detect crime and protect life and property.

The use of this framework is not a replacement for day to day information sharing processes that exist between agencies when there are concerns about individuals which must be raised as per the Multi Agency Safeguarding Policy and Procedures 2015. Individual enquiries should not be delayed whilst waiting to convene an LSE meetings or multi-agency meetings.

The policy applies to adult(s) at risk who are individuals known to or appear to be in need of care and support. This includes adults who fund their own care and support.

References to legal, central government and other external documents

The Care Act 2014

Care and Support Statutory Guidance 2016

The Health and Social Care Act 2008

The Care Quality Commission (Registration) Regulations 2009

ADASS Safeguarding Adults Policy Network Guidance June 2016

Gaining access to an adult suspected to be at risk of neglect or abuse: a guide for social workers and their managers in England (SCIE 2014)

Hampshire County Council Adults’ Health and Care references

Multi agency policy – PAN Hampshire and Isle of Wight Framework on Safeguarding in Commissioned Services (February 2015)

Safeguarding Allegations Management Advisor (SAMA) Policy 2016

CQC Enforcement policy February 2016

Provider Failure Policy 2016

Safeguarding Review Policy

Authority to vary

Departmental Management Team

Care Governance Board

Duties / responsibilities / roles

Duties and Responsibilities in relation to Adults’ Health and Care and partner agencies are detailed in the main content of the policy.

Contents

Purpose and scope of the guidance / 2
1 / Section one: Introduction / 6
2 / Section two: Main content / 7
2.1 / Guiding principles / 7
2.2 / Criteria for a large scale enquiry (LSE) / 9
2.3 / Hampshire County Council care residential & nursing homes / 10
2.4 / Alleged abuser Hampshire County Council staff members / 10
2.5 / Recording of LSE cases / 11
2.6 / Good Practice in Organisational Enquiries / 11
3 / Section three - Stages of the LSE process / 12
3.1 / Stage 1 - key actions to consider / 13
3.2 / Stage 2 - Proceed to LSE / 13
3.3 / Stage 3 - LSE planning meeting / 14
3.4 / The following should be considered to be invited to attend / 15
3.5 / Adult at risk / 16
3.6 / Stage 4 - The following should be discussed at the initial meeting / 17
3.7 / “Pause and review”- Does the LSE need to continue? / 19
3.8 / Stage 5 - LSE and other safeguarding activity / 19
3.9 / Stage 6 - “Pause and review” Does the LSE need to continue / 21
3.10 / Stage 7 - LSE review meetings / 21
3.11 / The following should be considered at any further review meetings / 22
3.12 / Evaluation of the evidence/outcomes / 23
3.13 / Stage 8 - LSE closure / 24
4 / Section four – Roles and responsibilities of stakeholders / 26
4.1 / Cross Boundary Considerations / 26
4.2 / Host Local Authority / 26
4.3 / Placing Authorities / 29
4.4 / Self Funders / 29
4.5 / Service Providers / 29
4.6 / Police / 32
4.7 / Health partners / 33
4.8 / Care Quality Commission (CQC) / 33
5 / Section five – Supplementary considerations / 35
5.1 / Quality Outcomes and Contract Monitoring (QOCM) framework / 35
5.2 / Contract remediation, purchasing restrictions and warning notices / 36
5.3 / CQC Enforcement / 37
5.4 / The escalation process / 38
5.4 / Provider failure / 38
5.6 / Impact of LSE on business sustainability of the provider / 39
5.7 / The person alleged to have caused harm / 39
5.8 / Referrer / whistle-blower / 40
5.9 / Communication plan / 40
5.10 / Media handling / 40
5.11 / Learning from LSE / 41
6 / Section six: Implementation considerations / 42
7 / Section seven - Appendices / 43
Appendix 1 - meeting checklist / 44
Appendix 2 - letter to the service user / 46
Appendix 3 - letter to family/representatives / 47
Appendix 4 - letter to provider subject to the LSE process / 48
Appendix 5 - LSE with remediation notice from contracts team / 49
Appendix 6 - letter to commissioning organisation / other funding authority / 51
Appendix 7 - Adults’ Health and Care response to CQC enforcement action / 52
Appendix 8 - LSE chronology / 53
Appendix 9 - summary of adults at risk, commissioners, next of kin, GP / 55
Appendix 10 - summary of section 42 enquiries and safeguarding concerns / 56
Appendix 11 - glossary and acronyms / 58

Section one - Introduction

All adult safeguarding occurs within the legal framework of the Care Act 2014. The statutory Care Act guidance defines adult safeguarding as:

“Protecting an adult’s right to live in safety, free from abuse and neglect. It is about people and organisations working together to prevent and stop both the risks and experience of abuse or neglect, whilst at the same time making sure that the adult’s wellbeing is promoted.”

The Care Act 2014 requires that each local authority must: make enquiries, or cause others to do so, if it believes an adult is experiencing, or is at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to prevent or stop abuse or neglect, and if so, by whom.

The LSE Policy and associated processes are intended to be used in the most serious of circumstances where there is a high level of risk and complexity.

An LSE response is part of the continuum of a whole system’s approach to safeguarding activity that may be an appropriate response to safeguarding concerns in a provider setting.

Outside of an LSE response there are also a number of safeguarding activities that may be appropriate, in relation to enquiries about safeguarding concerns, in commissioned services. These include the Quality Outcomes and Contract Monitoring (QOCM) framework which is an integral part of all safeguarding activity within Hampshire County Council.

Instances of poor practice in a service that have not resulted in harm or abuse should be managed as part of the QOCM framework.

Provider response

(The Local Authority causes the provider to make Section 42 enquiries with an agreed remit and format, performance management, and a misconduct procedure.)

CQC response

(Unsafe care and regulatory breaches, concern about registered manager or organisation.)

Commissioning response

(Quality and poor care, organisational concerns, including where there is a contractual breach.)

The policy aims to provide guidance to support Adults’ Health and Care with decision making when dealing with LSE enquiries. It is therefore not an exhaustive list of actions.

Section 2 – Main Content – Guiding Principles

Where an accumulation of quality issues or safeguarding enquiries provoke concern, it may be appropriate to consider this at an organisational level. The Care Act defines this as ‘organisational abuse’. Chapter 14.17 of the Care and Support Statutory guidance issued under the Care Act defines ‘organisational abuse’ as:

“..... the mistreatment or abuse or neglect of an adult at risk by a regime or individual’s within settings and services that adults at risk live in or use, that violate the person’s dignity, resulting in lack of respect for their human rights.” (Statutory Guidance, 2014)

The following six principles underpin all safeguarding activity, including an LSE.

Empowerment / People being supported and encouraged to make their own decisions and informed consent.
Prevention / It is better to take action before harm occurs
Proportionality / The least intrusive response appropriate to the risk presented
Protection / Support and representation for those in greatest need
Partnerships / Local solutions through services working with their communities
Accountability / Accountability and transparency indelivering
Safeguarding

This guidance does not negate the need for individual safeguarding concerns to be addressed via the individual safeguarding processes; it is not a replacement for the management of individual concerns.

All agencies receiving safeguarding concerns need to consider the possibility that more than one adult may potentially be at risk. It is essential that collaborative working and appropriate sharing of information across agencies takes place to identify any current or previous enquiries and allegations involving any named individuals or organisations.

As with any safeguarding enquiry, the governing principles of safeguarding apply and must be followed as the concerns are investigated.

These are:

Adults at risk are listened to and what they have to say is taken seriously and acted upon in an appropriate manner.

Individuals have a right to privacy; to be treated with dignity and to be enabled to live an independent life.

Everyone’s circumstances are different. Individuals should be able to exercise choice about how they lead their lives and have their rights upheld, regardless of ethnic origin, gender, sexuality, disability, age, religious or cultural background and beliefs.

Intervention should be proportionate to the harm or possibility of future harm, and which has the overall effect (outcome) of improving the life of the adult(s) at risk.

All responses to safeguarding concerns should consider an outcome which supports or offers the opportunity for the adult to develop or to maintain, a private life. This includes those people with whom the adult wishes to establish, develop or continue a relationship and must reflect their right to make an informed choice.

Where adults lack capacity to make relevant decision themselves, other people will need to make those decisions on their behalf. In doing so, they will act as a decision maker and will make “best interest decisions” on their behalf in accordance with the Mental Capacity Act 2005 and associated Code of Practice.

Where it is suspected that a crime may have been committed the police must be alerted at the earliest possible opportunity.

2.2 Criteria for a Large Scale Enquiry (LSE)

The Hampshire Adults’ Health and Care LSE policy is only intended to be used in response to the most serious of circumstances where there is a high level of risk and complexity. These circumstances mean that a high level of management influence and co-ordination is required over and above what is required in other safeguarding activities.

A safeguarding enquiry into a provider service as well as an individual adult at risk can be carried out without the instigation of the LSE process detailed in this policy.

Circumstances where instigation of the LSE process could be considered appropriate include, but are not limited to circumstances where:

The safeguarding concerns involve serious organisational abuse with evidence of criminal neglect, ill treatment, network abuse, death.

It is suspected that a number of adults at risk have been abused by the same perpetrator, or by a group of perpetrators or in the same setting.

There is clear evidence from safeguarding activities relating to an individual adult that other service users are at risk of significant harm.

A provider has failed to engage with other safeguarding activities to date resulting in continued harm or continued risk of harm to one or more adult at risk.

There is clear evidence that despite contract monitoring, quality improvement and/ or CQC rating review action planning; there is insufficient evidence of improvements within the service resulting in continued harm or continued risk of harm to one or more adult at risk.

Provider failure, due to financial, regulatory or other reasons. (However an LSE response may not be required. Reference should be made to the Provider failure policy for further guidance).

There are significant public protection/community safety concerns.

This is not an exhaustive list. Professional judgement should always be used to determine the most proportionate response to concerns.

The decision owner in relation to the application of the LSE policy is the district service manager (DSM) in consultation with the safeguarding and governance consultant, team manager and any other relevant parties.

There are a number of letters which should be used by the DSM when communicating with interested parties. (See appendices).

/ The decision, decision maker and rationale for the decision should be recorded in provider view as soon as this has been agreed. This should include a request to QOCM flag mail box (sshqqocm) for safeguarding flag to be added to the providers AIS record.
Provider View / NB - where Hampshire Adults’ Health and Care does not
commission services a request should be made for a provider
to be added to provider view using the provider request form.

2.3 Hampshire County Council care residential & nursing homes

Where an LSE response to safeguarding concerns in a Hampshire County Council care (in house) home is required the investigation should be co-ordinated by a DSM in another area different from the one in which the home is based. This enables Hampshire County Council to apply a level of independence to the LSE process.

Meetings should be chaired by a safeguarding and governance consultant from another geographical area. If the enquiry has a higher profile or is linked to very serious issues of risk or harm then a request to chair the meeting should be made to the head of service or the Strategic Service Manager for Safeguarding, Quality and Governance.

2.4 Alleged abuser Hampshire County Council staff members

Careful consideration should be given to a situation where the practice of operational staff needs to be investigated. This is the responsibility of the employer in line with organisational HR policies and procedures.

It is not appropriate for a colleague to investigate a peer. HR advice should be sought from the agency involved to ensure appropriate procedures are followed. A referral should be made to the Hampshire County Council Safeguarding Allegations Management Advisor (SAMA) at the earliest opportunity.

2.5 Recording of LSE Cases

The Safeguarding, Quality and Governance Team are responsible for ensuring there is an up to date record of all LSEs being undertaken in the county.

It is the responsibility of all practitioners involved in LSEs to follow the agreed protocol in relation to the logging of LSE enquiries. It is vital that provider view is updated promptly by all practitioners and that a safeguarding flag is added promptly and removed as soon as appropriate.

Adults’ Health and Care will allocate a delegated ‘lead’ to start the LSE chronology. This will be on Hantsfile and also in appendix seven. The lead needs to add the link to the chronology onto provider view. Below is a link on how to add a chronology to provider view. The LSE chronology will contain all activities in the case and should be updated by the lead, team manager and safeguarding, Quality and Governance consultant (no personal data in relation to a service user should be contained in the chronology). See Appendix 8 for template.

How to add a chronology to Provider view in AIS

2.6 Good Practice in Organisational Enquiries

When a safeguarding adults concern involves a number of adults and a number of placing authorities, the task of coordinating the enquiry becomes much more complex. Whilst the roles and responsibilities are principally unchanged when there is such an enquiry, it is essential that all authorities have a clear understanding of their respective roles and responsibilities, regardless of distance from the service where the alleged concerns arose.

All placing authorities must actively support the host authority to ensure no further risk is posed to any adult affected by the issues under an enquiry. There are some key matters, which, if managed carefully, will support the progress of the enquiry. The key difference is that organisational enquiries have wider strategic implications and careful consideration is required to ensure effective, timely and responsive actions.