Protecting adults at risk in London: Good practice resource
Cross-borough protocol: Issues to consider
Where the person who caused the harm is also a vulnerable adult
The funding/placing authority for the person who has caused the harm is responsible for their assessment, including risk assessment and providing support as required. If the person who has caused the harm is self-funding, the above responsibilities fall to the host authority.
The host authority has responsibility for investigating concerns raised about residents where no other local authority or community health service has made arrangements for their current placement. These residents are commonly known as ‘self-funders’. Self-funders should receive an equal service in relation to securing their safety as those in placements contracted by a statutory agency.
Where concerns are raised about a service provider, but self-funding residents are not identified as individual alleged victims, the host authority has the responsibility to review the potential impact of the concerns on the care provided to self-funding residents.
Safeguarding children procedures cover children and young adults up to the age of 18 years. Safeguarding adults procedures cover all adults from the age of 18 years.
If concerns are raised about a provider that supplies services for individuals both under and over 18 from the host authority and funding/placing authority, children and adults safeguarding services from the host authority will jointly coordinate the strategy meeting to plan any investigation necessary.
When an alleged victim is over 18 by the time the safeguarding incident is reported, but the incident occurred prior to the individual reaching 18, children and young people’s services should lead any investigation into the concern.
If the responsibility for case management of a service user lies with transitional services within children and young people’s services when the safeguarding alert is made, this responsibility will remain throughout the investigation. Any discussion/agreement to transfer responsibility should be made subsequent to, and not as part of, the investigation.
Continuing health care
During the safeguarding adults process it is possible to carry out a reassessment of the individual’s needs. If as a result they are assessed as eligible for continuing health care, funding responsibility to meet the individual’s needs transfers from the funding/placing authority to the NHS.
It is recognised that this change may place the individual at increased risk of harm due to unclear organisational boundaries of responsibility. However, once responsibility is transferred, the NHS has a statutory responsibility to provide care management for the individual, unless a Section 75 partnership agreement under the National Health Service Act 2006 exists.
Where an individual has been identified at the referral stage as being placed by a community health service under continuing health care arrangements, the NHS will be expected to fulfil the requirements of the funding/placing authority as outlined here, subject to the comment above on Section 75.
Areas of difficulty or dispute
The SAM – with the host authority – must immediately report any situations of exceptionally high risk to their senior manager, for example:
- where the provider can no longer meet the needs of the adult at risk and/or other service users, and an alternative is not immediately available
- where there is disagreement about funding
- where funding/placing authorities fail to meet their commitments.
Senior managers with the host authority and funding/placing authority need to resolve such difficulties and disputes by referencing the cross-borough protocol.
Areas for negotiation
We recognise that this protocol will not cover all situations that can arise. In principle the host authority will always be the authority where the alleged abuse took place, and both the host authority and the funding/placing authority must act to fulfil their respective responsibilities. However, circumstances can arise where it is good practice to negotiate between the host authority and the funding/placing authority.
For example, if a funding/placing authority or its local health commissioner has contracted a number of placements in a care home or specialist health provision in another local authority area, then a local protocol could be agreed to give the funding/placing authority overall responsibility for the coordination of any investigation into allegations relating to these residents. Similarly, if the person who has been abused was only a transient visitor in another local authority area (e.g. reported abuse by a carer on a day trip out), then it may be appropriate for the funding/placing authority to be responsible for the coordination of the investigation.
Other complex situations that may involve some negotiation include:
- indications of abuse by family, friends or paid staff in the borough the person is ordinarily resident in, are noticed when a person is admitted to an acute trust or respite care in another borough
- an adult at risk moves from one area to another and then discloses that abuse occurred at their last address.
In such cases, the main role of the authority where the abuse or neglect comes to light is to act as an alerter, ensure the person is safe and provide a link with the statutory services in their area (police, health trust, etc). The key responsibility for managing the coordinated response to the alleged abuse falls to the authority where the abuse is sourced, as there may be implications for other vulnerable adults or children in that area, and the protection plan will have to be agreed by that local authority.
During such a negotiation it is useful to consider:
- if this is a ‘one off’ set of circumstances where a single agreement is needed, or if it is a set of circumstances that are likely to recur and need an appropriate local written agreement
- the most effective working arrangements and relationships to complete the appropriate level of investigation and protection
- if there are wider concerns for any other adults at risk who may be affected or who are at risk of being affected by the circumstances of what is alleged
- where these other adults at risk are located and who is responsible for them; this will help determine which local authority should lead any investigation.
All the authorities involved should maintain records of the alleged abuse, and include these cases in their statistics.