Lincolnshire Safeguarding Adults Board

About the LSAB

The Lincolnshire Safeguarding Adults Board (LSAB) promotes the well-being of adults who have care or support needs.

There are many types of abuse that the LSAB deals with. For definitions of the different types of abuse, read the care and support statutory guidance on GOV.uk

If you are a professional you can report a concern using our reporting form.

Our strategy

The vision of the LSAB is to make Lincolnshire a place where adults feel safe, secure and free from abuse or harm.

For details on how we plan to achieve this, read the LSAB Strategy 2018-2021.

To find out how well we are achieving our strategic aims, read our annual report.

Our partners

  • Boston Borough Council
  • Diocese of Lincoln
  • East Lindsey District Council
  • HWLincs
  • Humberside, Lincolnshire, and North Yorkshire Community Rehabilitation Company
  • HM Prison Lincoln
  • Lincoln City Council
  • Lincolnshire Care Association
  • Lincolnshire CCG
  • Lincolnshire Community Health Services NHS Trust
  • Lincolnshire County Council
  • Lincolnshire Fire and Rescue
  • Lincolnshire Police
  • Lincolnshire Partnership NHS Foundation Trust
  • National Probation Service
  • North Kesteven District Council
  • South Holland District Council
  • South Kesteven District Council
  • United Lincolnshire Hospitals NHS Trust
  • West Lindsey District Council

Our policies

Our policies and procedures are for all agencies and individuals involved in safeguarding adults. This includes professionals, volunteers and staff working in public, voluntary and private sector organisations.

View the LSAB policies and procedures document.

For more information about the LSAB email [email protected].

Safeguarding Adults Reviews

By law, a Safeguarding Adults Review (SAR) must take place when:

  • an adult 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 them

The purpose of a SAR is not to assign blame. It is to promote learning and improvements to prevent future deaths or serious harm.

Current reviews:

LSAB training

The LSAB offers safeguarding training to practitioners who work with adults and their families. 

The training is delivered face to face training and via e-learning courses.

The training identifies which groups of staff the training is appropriate for using the National Competency Framework for Safeguarding Children and adults.

The Safeguarding Adults Framework Evaluation (SAFE) tool aims to help staff and others. It supports them to evaluate, reflect and learn from practice when working to safeguard adults.

For training queries, email [email protected].

LSAB resources

There are tools available to support professionals in safeguarding adults within Lincolnshire:

Partnership information report

If you have information about a person at risk, please complete a Partnership Information Report. This is known locally as Operation Insignia.

It is a multi-agency system of sharing information with Lincolnshire Police. It helps to support vulnerable children and adults. 

Your information will help form a picture around their situation. It will also allow police to take further action in investigating an issue.

This could include but is not limited to information that is indicating:

  • child exploitation (criminal and sexual)
  • human trafficking
  • modern slavery
  • county lines
  • cuckooing
  • knife crime

Please note: this form is for low-level information only, to enable Lincolnshire Police to build a picture on concerns. It is in no way a method to report crimes. The right methods are: ringing 101 or 999, or using the online crime reporting system.

Complete a partnership information report

The report should be for matters at a lower level than you would notify the Police by ringing 999 or 101, but still important to share.

It is not to answer current safeguarding concerns or matters of urgency, and the form is not a means to ensure safeguarding actions. 

If it is about significant harm to a child or vulnerable adult, normal safeguarding procedures apply.

Once received Lincolnshire Police will grade the information based on reliability, accuracy and origin. 

Never assume someone else has passed on the information you have.

If you have any queries about completing the form, contact [email protected].

Team Around the Adult

We support the approach offered through:

  • the Vulnerable Adult Panel
  • or similar District Council multi disciplinary meeting

We aim to work with complex cases. 

The process is overseen by an appointed Principal Practitioner. They will act as coordinator. 

It will involve the appointment of a Lead Professional, who will usually be the key worker. They will:

  • engage with the individual
  • promote multi-agency working
  • utilise a shared IT system

This may be through a case discussion or consultation. The coordinators can be contacted at [email protected]. They will respond within 48 hours.

A creative multi agency approach aims is to achieve change where more traditional methods don't work.

You can find out more about what we do in the TAA Operating Procedures and the E-CINS Operating Procedures. Also view our Revised Triage Tool for more information. 

Stephen’s Story

Stephen is 73 years of age and throughout his career he has had responsibility for other people's well-being.  When he found himself on the receiving end of services, he felt many emotions such as failure and embarrassment leading to a subsequent withdrawal. 
His circumstances had changed when his marriage broke down, and he found himself living alone and isolated from support.  He turned to alcohol for comfort, which is where the cycle of self-neglect began. His house deteriorated into a very poor state, his health suffered  and he wouldn't engage with services that could help him. 
   
In collaboration with the TAA, the Well Being Service adopted a low-key approach working at Stephen's pace to build a relationship with him, to talk through the possible options and to find out what he wanted.  Stephen has now moved and he is settled and happy in his new flat. His desire for a better life coupled with the hard work of the support services around him have resulted in him no longer using alcohol as a coping mechanism. He is settled and happy and is a visibly different man.

Stephen agreed to make a short film to explain his story and Debbie Leigh talks about the role of the TAA and how she worked collaboratively with Stephen and the Well Being Service.

Find out more about Stephen’s story.

Making Safeguarding Personal

The following 4 points are designed to be used at all stages in the safeguarding process, from identification of a concern through to closure.

Ask

  • understand the situation from the person's perspective and gather the facts using a strength’s-based approach
  • what are their views and wishes?
  • what are they worried about?
  • what do they want to happen? What outcomes would the person like to achieve?
  • what's working well? Discuss the person's strengths and what helps them to be safe
  • what needs to happen next?

Listen

  • listen carefully to what they are saying
  • consider how the person usually communicates and any tools that may assist them in this
  • give the person time and space to share what they feel is important information
  • listen with empathy and respect and without judgement
  • try to record what the person is saying in their own words
  • pay attention to non-verbal communication

Offer choice

  • empower them to make their own choices
  • consider the person's capacity to make relevant decisions, when they may need support with this, and who can provide this support
  • ask who they would like to be involved?
  • be open and honest about when consent is needed and when action may be taken without consent
  • be clear about what safeguarding is, who will be involved and what information will be shared with who
  • be honest about what can be achieved

Work together

  • build and maintain a positive relationship with the person and work in partnership with them to achieve their desired outcomes
  • ensure the enquiry is conducted at the person's pace
  • establish how the person, or their advocate, wants to be involved and agree how this will be achieved
  • share information with the person at every stage and check what they would like to happen next at every stage
  • as the enquiry progresses, assist the person to review risks and rethink the outcomes if required
  • discuss and agree when the outcomes have been met as far as possible and confirm when safeguarding support will end
  • feedback, did we meet their desired outcome?

Making Safeguarding Personal (MSP) sits firmly within the Department of Health (DH) Care and Support Statutory Guidance and revised in 2021 to support the Care Act (2014).

It means safeguarding adults:

  • is person-led
  • is outcome-focused
  • engages the person and enhances involvement, choice and control
  • improves quality of life, wellbeing and safety (paragraph 14.15)

Making Safeguarding Personal must not simply be seen in the context of a formal safeguarding enquiry (Care Act, 2014, Section 42 enquiry2), but also in the whole spectrum of safeguarding activity.

MSP is a shift in culture and practice in response to what we now know about what makes safeguarding more or less effective from the perspective of the person being safeguarded.

It is about having conversations with people about how we might respond in 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 and their family or advocate. It is about collecting information about the extent to which this shift has a positive impact on people’s lives. It is a shift from a process supported by conversations to a series of conversations supported by a process.

How has this been implemented in Lincolnshire?

In Lincolnshire the Safeguarding Adults Board (LSAB) is striving to develop a safeguarding culture that focuses on the personalised outcomes desired by people with care and support needs who may have been abused or at risk of abuse. Making Safeguarding Personal forms part of the LSAB strategy.

Embed the Making Safeguarding Personal approach within all partner agencies

The Making Safeguarding Personal (MSP) approach, puts service users' at the centre of everything we do, follows the edict of ‘no decision about me without me’, and means that the person, their families and carers must work together with agencies to find the right solutions to keep people safe and support them in making informed choices.

Moving forward, we now want to drive a cultural shift in all partner organisations that will embed the principles of MSP into their structures, processes and practice.

The key focus is on developing a real understanding of what people wish to achieve, agreeing, negotiating and recording their desired outcomes, working out with them, their family or advocates how best those outcomes might be realised and then checking at the end how far their expectations have been met.

How will this safeguard Adults with care and support needs?

Making Safeguarding Personal is not about putting the individual through a process it is about having a conversation with them or their representative to ask what has happened.

We will:

  • ask if they require any immediate support to keep them safe
  • explain how safeguarding works
  • ask what they would like to happen and support them in a way to give them choice and control to improve their quality of life, wellbeing and safety

We promise to:

  • listen to them
  • understand their views and wishes
  • take them seriously
  • treat them with respect
  • support them to feel as safe as they want
  • support them to make their own decisions
  • keep them informed and involved
  • tell them what will happen next

An Individual’s Perspective

Where the principles of MSP are applied effectively, an individual would be able to agree with the following statements.

People worked together to reduce the risk to my safety and wellbeing;

  • I had the information I needed, in the way that I needed it
  • professionals helped me to plan ahead and manage the risks that were important to me
  • people and services understood me - recognised and respected what I could do and what I needed help with
  • the people I wanted were involved
  • I had good quality care - I felt safe and in control
  • when things started to go wrong, people around me noticed and acted early

People worked together and helped when I was harmed;

  • people noticed and acted
  • I felt listened to
  • people asked what I wanted to happen and worked together with me to get it
  • the people I wanted were involved,
  • I got the help I needed by those in the best placed to give it
  • the help I received made my situation better
  • people will learn from my experience and use it to help others
  • I understood the reasons when decisions were made that I didn’t agree with

Translating Principles into Outcomes

The Care Act 2014 reiterates the following six principles of safeguarding, which 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
  • criminal justice system

The principles should inform the ways in which professionals and other staff work with adults. The principles can also help SABs, and organisations more widely, by using them to examine and improve their local arrangements.

Six key principles underpin all adult safeguarding work:

  • Empowerment – people being supported and encouraged to make their own decisions and informed consent

    “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

    “I receive clear and simple information about what abuse is, how to recognise the signs and what I can do to seek help.”
  • Proportionality – the least intrusive response appropriate to the risk presented

    “I am sure that the professionals will work in my interest, as I see them and they will only get involved as much as needed.”
  • Protection – support and representation for those in greatest need

    “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.”
  • Partnership – local solutions through services working with their communities, communities have a part to play in preventing, detecting and reporting neglect and abuse

    “I know that staff 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 – accountability and transparency in delivering safeguarding

    “I understand the role of everyone involved in my life and so do they.”

In addition to these principles, it is also important that all safeguarding partners take a broad community approach to establishing safeguarding arrangements. It is vital that all organisations recognise that adult safeguarding arrangements are there to protect individuals.

We all have different preferences, histories, circumstances and life-styles, so it is unhelpful to prescribe a process that must be followed whenever a concern is raised.

Making Safeguarding Personal means it should be person-led and outcome-focused. It engages the person in a conversation about how best to respond to their safeguarding situation in a way that enhances involvement, choice and control as well as improving quality of life, wellbeing and safety.

Nevertheless, there are key issues that local authorities and their partners should consider if they suspect or are made aware of abuse or neglect.

Some people may express desired outcomes or wishes that are not possible, and this provides opportunities for frank discussion to establish what the next best option is within some broader boundaries and principles that they have stated.

For other people their desired outcomes may not be possible for instance if they don’t want the police involved but the person who has abused or neglected them is in a position to do the same to others. Again there will be opportunities to explain this honestly and to find ways to most closely meet their wishes.

Assurance Programme

As part of the LSAB assurance process, MSP is featured as key topic for assurance.

In early 2020 a multi-agency MSP case file audit was undertaken. The aim of the audit was to give a snap shot of the use of MSP in safeguarding practice across agencies, and included cases where partner agencies held responsibility for undertaking the Section 42 safeguarding enquiry.

Audits were completed according to an audit tool, split into 4 sections:

  • pre safeguarding concern
  • safeguarding concern form
  • safeguarding enquiry
  • closure

Auditors were asked to answer questions within each section by providing supporting and opposing evidence sourced from Mosaic; and then make an overall judgement from 1 – 10 (1: limited or no aspects of good practice, 10: excellent MSP practice) for each section, resulting in a possible 4 scores for each case audited.

Scores were reviewed and presented in a report to both the LSAB Executive Board and its Partnership Board for consideration with the report offering 2 key recommendations.

  1. the Board should revive its MSP promotion and promotional material and create a campaign of awareness across agencies and frontline staff
  2. the MSP audit undertaken in early 2020 should be repeated in 2021 and after the promotional campaign to establish if improvement has been made
  3. aN LSAB training package was created around MSP available to all partners

Did not attend or was not supported to attend guidance

Aim

This guidance aims to ensure:

  • there is consideration of why an adult with needs for care and support might fail to attend a health appointment
  • they are individually assessed and managed with consideration to their welfare

Where an adult who does not have care and support needs may be at risk of domestic abuse, you should follow your organisation's policy for responding to concerns of domestic abuse.
If you believe that a crime has been committed and there is an immediate danger, call the police on 999 or 112. If there is no immediate danger, call the police on 101.

Introduction

Not all circumstances where an adult with care and support needs fails to attend a health appointment will raise concerns. In most cases there will be reasonable explanation. However, all clinical and non-clinical staff have a duty to safeguard adults by recognising abuse and referring onwards as appropriate.

A single missed appointment is unlikely to be a cause for concern.  It will depend on the likely impact and other factors such as time since the person was last seen. However, numerous studies have shown that missing healthcare appointments is a feature in many Safeguarding Adult Reviews and Domestic Homicide Reviews and it can be a precursor to abuse. Therefore, for some adults, missing appointments may be an indicator that they are at an increased risk of abuse and, or neglect.

Within Health there is a move towards the concept of ‘Was Not Brought’ (WNB) rather than Did Not Attend (DNA) for children and young people. This guidance seeks to use this concept for adults but replaces the term 'Was Not Brought' with 'Was Not Supported to Attend'. Where an adult may rely upon a carer, family or friend to bring them to appointments due to their care and support needs, this should be considered in the context of 'was not supported to attend' rather than 'did not attend'.

For the purpose of this guidance, the failed appointment refers to any type of pre-arranged appointment, in any pre-arranged location where the adult (or carer) either:

  • cancels the appointment
  • fails to attend
  • was not supported to attend, or
  • the service provider cancels the appointment

Cancellation of appointment by the service

On any occasion that an appointment may need to be cancelled by staff within a service, then that service will be responsible for ensuring that prior to the appointment being cancelled:

  • any risk to the service user is identified
  • a further appointment is arranged as soon as possible

Cancellation of appointment by individual, carer, relative or friend

Where an appointment is cancelled it is good practice to attempt to understand the reason for the cancellation:

  • If it is a regular occurrence, is the appointment usually rearranged and subsequently attended? 
  • Are they cancelling all future appointments for a service which is deemed necessary or where the adult is known to be at risk?

Where a person is cancelling for another person it can be important to speak to the person who the appointment is for, to clarify the above. Consideration should be given whether a carer, relative or friend may need:

  • additional support
  • appropriate advice and information
  • onward referrals

All staff should use professional curiosity when people are cancelling services or appointments for a service which is deemed necessary for care, health and wellbeing.

Did not attend (DNA) or was not supported to attend (WNSA)

This guidance sets out three areas to consider if the adult did not attend or was not supported to attend:

  • If this is the first time an appointment has been missed, there is no indication that the individual has care and support needs then the normal appointment DNA process should be followed.
  • If the adult has been identified as having care and support needs and has not attended two consecutive appointments then this guidance should be followed.
  • If, as a result of initial enquiries, there is a reasonable belief that the adult is at risk of, or may be experiencing abuse or neglect, then this guidance should be followed.

Eligibility criteria under the Care Act 2014

Staff will need to use their professional judgement in order to assess possible risks to the adult and apply the most appropriate and proportionate response.

Whilst the use of a letter is being cited as the standard form of communication with adults or carers, additional methods of communication may be used where inappropriate. For example, where there is:

  • visual impairment
  • learning disability
  • low level of literacy
  • other factors affecting an adults or carers ability to read or understand the letter’s instructions.

It is important to identify language barriers and recognise that English may not be the patient’s first language. Staff should always use appropriate interpreting services or literature in various languages.

Did not attend, was not supported to attend or appointment cancelled considerations

When the adult did not attend an appointment, was not supported to attend or the adult or their carer cancelled the appointment, please consider the following:

  • Are the adult's circumstances known to be recently unstable?
  • Are other services involved with the adult? Have you considered contacting these services?
  • What are the adults needs and risks?
  • What is the impact of the missed appointment upon the adult and their family?
  • Is the missed appointment necessary for the physical or mental health of the adult?
  • Does the missed appointment form a pattern of non-attendance?
  • Does missing the appointment signify a risk of immediate harm to themselves or others?
  • Are you aware of any current safeguarding issues?
  • Immediate steps to be taken?
  • How long is it since the adult was last seen by your service?

This is not an exhaustive list of considerations but is designed to support you in your thought process.

If an appointment has been cancelled, the individual did not turn up or was not supported to attend, consider the following actions:

First appointment missed

  • If this is the first time an appointment has been missed, there is no indication that the individual has care and support needs then the normal appointment did not attend process should be followed.
  • Follow your current did not attend process

Two consecutive appointments have been missed

If the adult has been identified as having care and support needs and was not supported to attend or did not attend two consecutive appointments then this guidance should be followed:

  • Attempt to contact the adult or carer based on their individual communication needs.
  • If contact is made, use professional curiosity to ascertain reasons for non-attendance. If no concerns identified, follow your current did not attend process.
  • If contact is not made or contact has raised concerns and you are aware that they are known to other agencies, contact these agencies to share your concerns and agree an appropriate course of action.
  • Record outcomes of attempted contact and discussions with other agencies and the agreed course of action.

Adult has been identified as having care and support needs and was not supported to attend or did not attend

If the adult has been identified as having care and support needs and was not supported to attend or did not attend and there are safeguarding concerns indicated for the adult, then this guidance should be followed:

  • Attempt to contact the adult or carer based on their individual communication needs.
  • If contact is made, use professional curiosity to ascertain reasons for non-attendance. If no concerns identified follow your current did not attend process.
  • If contact is not made or contact has raised concerns and you are aware that they are known to other agencies, contact these agencies to:
    • identify most recent contact
    • share your concerns
    • agree an appropriate course of action which may include making a safeguarding referral.
  • Record outcomes of attempted contact and discussions with other agencies and the agreed course of action

Mental Capacity Act

7 minute briefing on what is the Mental Capacity Act
 

Mental Capacity Act

The Mental Capacity Act (MCA) 2005 applies to everyone involved in the care, treatment and support of people aged 16 and over, living in England and Wales who are unable to make all or some decisions for themselves.

Accountability

All professionals have a duty to comply with the Mental Capacity Code of Practice. Resources available to support all practitioners in their understanding and duties under the Human Rights Act and MCA.

The five principles

The Act’s five statutory principles are the benchmark and must underpin all acts carried out and decisions taken in relation to the Act:

  1. Presumption of capacity
  2. Supporting to make own decisions
  3. Unwise decisions
  4. Best Interest
  5. Least restrictive

Assessment

Everyone has the right to make his or her own decisions. Health and care professionals should always assume an individual has the capacity to make a decision themselves, unless it is proved otherwise through a capacity assessment.

Two Stage Test

Anyone caring for or supporting a person who may lack capacity could be involved in assessing capacity:

  • Stage 1 - is there an impairment of or disturbance in the functioning of a person’s mind or brain
  • Stage 2 - is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision

Decision-making

Just because someone makes what those caring for them consider to be an “unwise” decision, they should not be treated as lacking the capacity to make that decision. Everyone has the right to make their own life choices, where they have the capacity to do so.

Best interest

Where capacity is a concern staff must complete a MCA form that is decision and time specific and supports the patient with decision-making. Where someone is judged not to have the capacity to make a specific decision (following a capacity assessment), that decision can be taken for them, but it must be in their best interests.