1.1. Sussex safeguarding adults policy

1.1.1. Introduction

The Care Act 2014 was a major step forward in safeguarding adults who are experiencing, or are at risk of, abuse or neglect, and are unable to protect themselves.

Sections 42 to 47 of the Care Act set out the legal duties and responsibilities in relation to adult safeguarding.

The legal framework for the Care Act 2014 is supported by Care and Support Statutory Guidance which provides information and guidance about how the Care Act should operate in practice. The guidance has statutory status which means that there is a legal duty to have regard to it when working with adults with needs for care and support and carers.

Safeguarding means protecting an adult’s right to live in safety, free from abuse and neglect. It is about working together to support people to make decisions about the risks they face in their own lives and protecting those who lack the mental capacity to make those decisions.

This policy and procedures provide an overarching framework to ensure a proportionate, timely and professional approach is taken, and that adult safeguarding is coordinated across all relevant agencies and organisations. This is essential for the prevention of harm and abuse.

The aims of adult safeguarding are to:

• Prevent harm and reduce the risk of abuse or neglect to adults with care and support needs.
• Stop abuse or neglect wherever possible.
• Safeguard adults in a way that supports them in making choices and having control about how they want to live.
• Promote an approach that concentrates on improving life for the adults concerned.
• Raise public awareness so that communities as a whole, alongside professionals, play their part in preventing, identifying and responding to abuse and neglect.
• Provide information and support in accessible ways to help people understand the different types of abuse, how to stay safe and what to do to raise a concern about the safety or wellbeing of an adult.

In order to achieve these aims it is essential that everyone, both individuals and in organisations, is clear about their roles and responsibilities in regard to safeguarding policy and procedures. Individual services and organisations should ensure their internal adult safeguarding policy and procedures reflect these Sussex safeguarding adults policy and procedures. This includes an expectation to report in a timely way any concerns or suspicions that an adult is at risk of being, or is, being abused. Where abuse or neglect takes place, it needs to be dealt with promptly and effectively, and in ways which are proportionate to the concern, ensuring that the adult stays in as much control of the decision-making as possible.

1.1.2. Statutory safeguarding principles

The Care Act safeguarding duties apply to an adult who:

• has needs for care and support (whether or not the local authority is meeting any of those needs),
• is experiencing, or at risk of, abuse or neglect,
• as a result of those care and support needs is unable to protect themselves from either the risk of, or the experience of abuse or neglect.

The framework for statutory adult safeguarding set out within the Care Act states that local authorities are required to:

• Lead a multi-agency local adult safeguarding system that seeks to prevent abuse and neglect and stop it quickly when it happens.
• Make enquiries, or ensure others do so, when they believe that an adult is subject to, or is at risk of, abuse or neglect. An enquiry should establish whether any action needs to be taken to stop or prevent abuse or neglect, and if so, by whom.
• Establish a Safeguarding Adults Board (SAB) with core membership from the local authority, the police and the NHS (specifically the Integrated Care Board) with the power to include other relevant bodies.
• Arrange, where appropriate, for an independent advocate to represent and support a person who is the subject of a safeguarding enquiry or Safeguarding Adults Review (SAR) where the adult has ‘substantial difficulty’ in being involved in the process and where there is no other appropriate adult to help them.
• Cooperate with each of its relevant partners in order to protect adults who are experiencing, or at risk of, abuse or neglect.

Promoting wellbeing

Professionals should always promote the adult’s wellbeing as part of safeguarding arrangements. People have many aspects to their lives and being safe may be only one of the things which are important to them. Professionals should work with each adult to establish what being safe means to them and how that can best be achieved.

1.1.3. Multi-agency working

Multi-agency working and safeguarding

Multi-agency working refers to a way of working that involves professionals from different agencies collaboratively combining their skills, expertise and knowledge, with the joint goal of meeting an individual’s needs, including multiple and compound needs. Good communication, common goals, understanding, and teamwork is essential for effective multi-agency working.

Working effectively together is critical to safeguarding to ensure that a high standard of coordinated care is provided to the adult, allowing them to feel better supported and more engaged within their own care. Multi-agency working allows for best practice, experience, and skill sharing, increasing learning opportunities and leads to positive working relationships which in turn, increases the likelihood of positive outcomes for the adult.

For more information, please see the Gov.uk 'Revisiting safeguarding practice' guidance on safeguarding practice, which references multi-agency working.

 A key area of learning identified in many SARs which are commissioned in Sussex is the need for more effective partnership working in order to protect the adult.

Sussex Reviews and their accompanying learning resources can be accessed on the Safeguarding Adults Board (SAB) websites for Brighton & Hove, East Sussex and West Sussex.

Multi-agency meetings

The Local Government Association (LGA) note that by working together, organisations can deliver value and outcomes that would be difficult or impossible to deliver working individually.

Therefore, multi-agency meetings, whether held in-person or virtually, are the best way to ensure there is effective information sharing and communication, as well as a shared responsibility for assessing risks to the adult and agreeing an action plan to aim to mitigate these risks.

It is important to note that any agency can convene a multi-agency meeting; this should be the agency who is most involved in supporting the individual. If there is an active Section 42 enquiry, where the local authority has caused others to undertake and enquiry, the agency leading on this can be responsible for progressing the multi-agency response.

There are circumstances when a meeting should be considered, such as:

• Responding to self-neglect
• Risk sharing and safety planning
• Coordinating the response to safeguarding concerns and the quality-of-care provision
• Coordinating criminal investigations and safeguarding enquiries
• Reviewing outcomes and agreeing a safeguarding plan
• Managing multiple safeguarding enquiries such as for organisational abuse

Multi-agency meetings should have a clear agenda addressing the areas which need to be covered, and a comprehensive record of actions agreed, by whom and within clear timescales. This would include agreement on who will lead on tasks in relation to risk and safety planning.

It is good practice to identify a professional/s to coordinate agencies and their response to adults with complex needs. The professional/s will act as a single point of contact for involved agencies and will maintain oversight of the work being undertaken to support the adult, ensuring there is alignment in practice across different organisations.

When actions and responsibilities are agreed within a multi-agency meeting, these must be clearly documented within the adult’s care records; this could include safeguarding plans, risk assessments, care plans, or case notes. This evidences what is being done to mitigate risk to the adult. All participating agencies should have a copy of the safeguarding plan or meeting minutes.

If a multi-agency meeting is not possible to convene, the work needed between professionals should still take place and this could be achieved virtually or via calls/emails to all agencies involved to gain the information needed, advice and to agree actions. The lead agency working with the adult would take this forward.

If there is a disagreement between professionals across agencies in the approach to an adult’s care, you should refer to our Sussex Safeguarding Escalation and Resolution Protocol (PDF, 214KB), which supports consistent and timely decision-making in relation to adult safeguarding. The protocol includes guidance in relation to mental capacity issues and safeguarding and has a streamlined escalation process that explicitly ensures relevant safeguarding leads are consulted at an appropriate point.

Important aspects of multi-agency working

Making Safeguarding Personal and recording information

Making Safeguarding Personal (MSP) is a national approach to promote responses to safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing, and safety. It is about seeing people as experts in their own lives and working alongside them to identify the outcomes they want, with the aim of enabling them to resolve their circumstances and support their recovery. The West Sussex SAR in respect of Beverley (PDF, 353KB) includes a statement from Beverley’s family encouraging practitioners to “reflect and strive to remember that within their individual roles, the most important person of a multidisciplinary team, is the person themselves.”

Therefore, agencies are encouraged to actively involve the adult in discussions about their care, and to ensure that written evidence of the adult’s views and thoughts are recorded and shared with relevant agencies. By doing so, the adult is kept central to the multi-disciplinary work taking place.

If a discussion with the adult is not possible or has not taken place, it is vital that the reason for this is also recorded in their care plan and/or other records. In addition, any multi-agency meeting where the person is not in attendance must consider the views of the adult and address how these will be responded to. views of family, carers, friends or advocates should be sought and also recorded to evidence that a person-centred approach has been adopted.

Information sharing

Sharing information with the right people at the right time is vital to good practice and effective safeguarding. It allows professionals to make fully informed decisions about what action is best to take and how. All agencies have a responsibility to share any relevant information they have which may protect an adult from abuse or neglect.

Ideally, adults should provide consent before information about them is shared. They have the right to refuse, however, this wish can be overridden in circumstances which place them and/or others at significant risk of harm. For more information, please see the Sussex Information Sharing Guide and Protocol (PDF, 614KB). There are also some useful resources on the SCIE website.

Multi-agency risk assessment

Risk assessment is the process of working with an adult to improve safety and to reduce future risk. Making Safeguarding Personal (MSP) is an integral part of safeguarding and professionals should adopt a strengths-based, flexible, and enabling approach to managing risk with the person and their network.

Casework involving significant risks often require a multi-agency approach, underpinned by clear and timely information sharing and shared risk-assessing resulting in multi-agency risk management plans. These should be proportionate and focussed on preventing, reducing or eliminating the future risk of harm. Risks can be evaluated through multi-agency meetings and should be reviewed regularly to reassess the level and nature of the risk.

Risk assessments and risk plans should clearly record:

• all relevant and anticipated risks
• the adult’s views and wishes
• what action is being taken and by whom
• any issues with mental capacity and how this is to be addressed including the need, where appropriate, for best interest decisions
• how the understanding of risk and the actions available to support is shared with the adult.

Communication and developing working relationships

Effective communication is essential to enable professionals to develop strong working relationships, trust and shared ownership when supporting an adult with care and support needs. When working together, professionals from across different organisations should seek to understand and respect each other’s roles in supporting the adult, as well as offering the flexibility which may be required to gain the best possible outcome for the adult. This will help to set expectations, clarify responsibilities; and avoid any misunderstanding when sharing work.

Supervision and management oversight

Skilled and knowledgeable supervision focused on outcomes for adults is critical in adult safeguarding. Managers have a central role in ensuring high standards of practice and that practitioners are properly equipped and supported. Employers should ensure they have robust management systems in place for training and support.

It is important that all safeguarding cases have supervision and management oversight. Supervision should encourage reflective practice and professional curiosity and should check that relevant actions to reduce risk to a vulnerable adult have been best explored in collaboration with multi-agency professionals.

Systems and processes

It is important to recognise that agencies often have different systems and processes, including for the way they record information. Access to this information to professionals outside of the organisation is often restricted. This emphasises the importance of information sharing with other agencies, which can be arranged through other methods of communication including emails, telephone calls, or multi-agency meetings.

Safeguarding Adults Board information and resources

There are a number of Board subgroups across Sussex, as well as protocols and frameworks to encourage collaborative, multi-agency working. For more information on these, please visit the Board websites:

• Brighton and Hove SAB
• East Sussex SAB
• West Sussex SAB

1.1.4. Making Safeguarding Personal

Making Safeguarding Personal (MSP) is a national approach to promote responses to safeguarding situations in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety. It is about seeing people as experts in their own lives and working alongside them to identify the outcomes they want, with the aim of enabling them to resolve their circumstances and support their recovery. Making Safeguarding Personal is also about collecting information about the extent to which this shift has a positive impact on people’s lives.

People are individuals with a variety of different preferences, histories, circumstances and life-styles. Safeguarding arrangements must not prescribe a process to be followed whenever a concern is raised, but rather Making Safeguarding Personal emphasises the importance of a person-centred approach, adopting the principle of ‘no decision about me without me’. Personalised care and support is for everyone, but some people will need more support than others to make choices and manage risks. A person led approach is supported by personalised information and advice and, where needed, access to advocacy support.

1.1.5. Key principles informing this policy

Six key principles underpin all adult safeguarding work. They apply to all sectors and settings including: care and support services, further education colleges, commissioning, regulation and provision of health and care services, social work, healthcare, welfare benefits, housing, wider local authority functions and the criminal justice system.

Empowerment

This is the presumption of person-led decisions and informed consent. In practice this means having clear and accessible systems for adult’s views to be heard and influence change and giving people relevant information and support about safeguarding and the choices available to them to ensure their own safety. An outcome for the adult at risk may be, “I am asked what I want as the outcomes from the safeguarding process and these directly inform what happens.”

Prevention

It is better to take action before harm occurs. In practice this means raising public awareness about safeguarding, including how to recognise and report it. All staff are clear on their roles and responsibilities in relation to safeguarding adults at risk. An outcome for the adult at risk may be, “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”

Proportionality

This is the least intrusive response appropriate to the risk presented. In practice this means the adult is at the centre of all responses to the safeguarding concern and any action taken is based on their preferred outcomes or best interests. It is an approach of positive risk taking in which the adult at risk is fully involved. An outcome for the adult at risk may be, “I am sure that the professionals will work in my interests, as I see them and they will only get involved as much as needed.”

Protection

This is support and representation for those in greatest need. In practice this means organisations having effective processes to be able to identify and respond to concerns or emerging risks. Consideration of mental capacity is part of the safeguarding process, and where people lack capacity decisions are always made in their best interests. An outcome for the adult at risk may be, “I get help and support to report abuse and neglect. I get help so that I am able to take part in the safeguarding process to the extent to which I want and to which I am able.”

Partnership

This means local solutions through services working with their communities. Communities have a part to play in preventing, detecting and reporting neglect and abuse. In practice this means information is shared between organisations in a way that reflects its personal and sensitive nature, and ensuring local information sharing protocols are in place and staff understand and use them. An outcome for the adult at risk may be, “I know that staff will treat any personal and sensitive information in confidence, only sharing what is helpful and necessary. I am confident that professionals will work together and with me to get the best result for me.”

Accountability

This is accountability and transparency in delivering safeguarding. In practice this means the roles and responsibilities of the organisation are clear so that staff understand what is expected of them and others. An outcome for the adult at risk may be, “I understand the role of everyone involved in my life and so do they.”

1.1.6. Trauma informed practice, care and approaches in adult safeguarding

What is trauma?

The term trauma can refer to a wide range of traumatic, abusive or neglectful events or series of events (including Adverse Childhood Experiences (ACEs) and trauma in adulthood) that are experienced as being emotionally or physically harmful or life threatening. Whether an event(s) is traumatic depends not only on our individual experience of the event, but also how it negatively impacts on our emotional, social, spiritual and physical wellbeing (National Trauma Training Programme - What is meant by trauma? (transformingpsychologicaltrauma.scot). Practitioners need to have an understanding that trauma exposure can impact on someone’s neurological, biological, psychological, and social development

Trauma, particularly in early childhood, can have a severe impact throughout a person’s life. For many children it can be expressed through behavioural issues, and often leads to having a severe effect on both mental and physical health. During adulthood the person is more likely to be drawn into violence, criminal activity, and self-harm, as well as being more likely to engage in health-harming behaviours (Bellis et al 2016).

Trauma informed practice/care and approaches

Being ‘Trauma Informed’ means being able to recognise when someone may be affected by trauma, collaboratively adjusting how we work to take this into account and responding in a way that supports recovery, does no harm and recognises and supports people's resilience. Trauma-informed care aims to increase practitioners’ awareness of how trauma can negatively impact on individuals and communities, and their ability to feel safe or develop trusting relationships with services and their staff.

Organisations must aim to improve the accessibility and quality of their services by creating culturally sensitive, safe services that people trust and want to use. Trauma informed care seeks to prepare practitioners to work in collaboration and partnership with people and empower them to make choices about their health and wellbeing’ (Office for Health Improvement and Disparities 2022 Working definition of trauma-informed practice - GOV.UK (www.gov.uk)).

Being “trauma informed” is multi-layered and requires a whole system approach. It applies to all areas of an organisation and across the system. This includes integrating trauma related aspects, knowledge, and concepts into things such as training, recruitment, induction, policies, procedures, mission statements, language used, having experts of experience, the environment, team meetings, supervision, reflective practice, leadership style and so much more (Treisman, 2017). Trauma-informed practice acknowledges the need to see beyond an individual’s presenting behaviours and to ask, ‘what has happened to you’ rather than ‘what is wrong with you?’.

In our Adult Safeguarding procedures this means that we are making a commitment to this approach, across Sussex and the three Safeguarding Adults Boards. This commitment should be visible in our safeguarding practice with people, and also ensuring this commitment through our policies, training and development and leadership.

The four R’s of trauma informed care are key factors in providing a trauma informed approach. SAMHSA (Substance Abuse and Mental Health Services Administration 2014, p.9-10):

• Realising how common the experience of trauma and adversity is
• Recognising the different ways that trauma can affect people
• Responding by taking account of the ways that people can be affected by trauma to support recovery
• Opportunities to Resist re-traumatisation and offer a greater sense of choice and control, empowerment, collaboration and safety with everyone that you have contact with.

This is expanded further in the working definition guide to Trauma Informed Practice: Working definition of trauma-informed practice - GOV.UK (www.gov.uk).

Trauma and safeguarding

Trauma-informed practice seeks to avoid re-traumatisation by using the principles of safety, trustworthiness, choice, collaboration, empowerment and cultural consideration (Office for Health Improvement and Disparities 2022). This aligns with the principles of adult safeguarding in the Care Act (2014), empowerment, prevention, proportionality, protection, partnership, accountability, and Making Safeguarding Personal approaches.

The impact of trauma is identified as a theme in many local and National Safeguarding Adult Reviews. The impact can be across the life course and often increasing further vulnerability and barriers to accessing services (see further reading). Trauma informed care ensures services are delivered in ways which prevent further harm and re-traumatisation. Trauma can affect people at any point in their life course and this should be recognised. Making sure that the person is at the centre of practice and the person is empowered in making choices being the expert of their own care, support, and safety planning.

Trauma informed safeguarding in practice

Recording in a trauma informed way

The Sussex thematic review regarding women with multiple compound needs identified a need for all professionals and agencies to change the language and terminology used in engaging with women who have multiple and compound needs. They noted that all three women were frequently described as having a ‘chaotic lifestyle’ or as being difficult to engage with but what they all had in common was that they had been exploited, mostly by men. They state that simple changes of language can have a substantial effect upon thinking – if we refer to them as ‘women who have been exploited’ then the fact that they have a chaotic lifestyle, or may be difficult to engage with, comes into the correct context or disappears altogether. This then changes the way in which we view the support they need and can reduce inequalities and barriers to accessing services.

“We know that language matters. Our words are powerful. The way we communicate with and about people reveals and shapes attitudes and behaviours. Some words lift people up and build bridges. And some words build walls and bring people down or exclude them altogether” (Think Local Act Personal).

Please see Multiple Compound Needs chapter and Self Neglect chapter for further reading.

Examples in practice

• Describing someone’s ‘possessions’ rather than ‘rubbish’ when a person is experiencing hoarding challenges.
• Change language from “She keeps changing her accounts to services, so we don’t know what actually happened” to “There is a risk of coercive control due to the variety of accounts given by the victim/survivor to agencies”.
• Change language from “There is no evidence to corroborate her account” to “There is insufficient evidence against the perpetrator for further action to be taken”.
• Change language from “These are just allegations” to “The victim/survivor has disclosed abuse”.
• Change language from “The onus is on the victim/survivor to engage with us” to “Does anyone have any suggestions on how to safely engage with the victim/survivor?”
• Change language from “She let him in, despite there being bail conditions in place” to “The perpetrator broke his bail conditions by attending the address”.
• Change language from “The victim/survivor failed to engage” to “Our agency was unable to engage with the victim/survivor”.
• Change language from “The victim/survivor is continuing to have contact with the perpetrator despite the risks” to “There is a risk due to the perpetrator continuing to have contact with the victim/survivor”.
• Change language from “She has placed herself at serious risk of abuse because of her substance use” to “The victim/survivor has substance use issues which increases her vulnerability”.

Source: Brighton and Hove Safeguarding Adults Board Thematic Review.

Understanding trauma and its impact on a person’s communication

It is vital to understand trauma responses. What is happening in the body when someone is traumatised or in advertently we are retraumatising them – we are working with them when they are in survival mode – what does that mean for ‘engagement’ and what may we see and experience?

Examples: when we aren’t able to engage someone it could be because they are dissociating or in fight or flight response to us actually trying to talk with them, or we may say something that triggers a trauma response and therefore in simplistic terms a person enters one of the trauma states (fight, flight, freeze or fawn). They change the subject, try to get away or stand up and show us how physically bigger they are than us. Also how a traumatised brain works e.g. focus/memory they will never remember because they are in a heightened state of anxiety that, for example, that we said we would meet them at the office on Tuesday at 10am. We should consider communication methods which may be able to facilitate contact and engagement which they would find easier to participate in for a first meeting for example. Are we flexible in our approach? When in a trauma state a person can’t process information in the way that people who aren’t in a trauma state can.

When liaising with multi agency partners, what do we understand of this person’s communication/what can we learn. What is successful and what is not. How do they engage (or not) about their trauma? What can we share about how this may present and the impact of this trauma in their responses and communication?, this will help us prepare to communicate and try to engage with this person? This can ensure we are delivering our making safeguarding personal approach in our practice.

Practice examples

• Communicating in a different way. Use letters/WhatsApp for questions for them to take away, digest and respond to when they are not in a heightened state of anxiety.
• Ensuring adequate preparation – taking the time to read the person’s notes before we contact them, preventing re traumatisation through re telling of their trauma, promoting building trust
• working in pairs to notice a person’s responses/language and taking opportunities immediately afterwards to reflect together – did you notice when I mentioned X he did Y etc. reviewing what worked and what seemed less successful.
• Giving a person information about how trauma impacts on interactions and developing formulation and work arounds that suits the person

Following the DJT Safeguarding Adults Review in West Sussex further learning on practice tips on providing a trauma informed approach in adult safeguarding have been developed: Trauma-informed approach learning briefing (PDF, 131K).