Sharing information barriers and solutions - Adult safeguarding: sharing information
Failures in communication and joint working
Adult serious case reviews frequently highlight failures between safeguarding partners (local authorities, GPs and health, the police, housing, care providers) to communicate and work jointly. Such failures can lead to serious abuse and harm and in some cases, even death.
How to improve communication and joint working
- Improve links between public protection forums: safeguarding boards, (children and adults), multi-agency risk assessment conferences (MARACs)*, multi-agency public protection arrangements (MAPPAs)**, health and wellbeing boards and community safety partnerships.
- Develop joint approaches to resolve concerns where the individual may not be eligible for social care support, for people who refuse support and those who self-neglect.
- Where appropriate, include partner agencies in enquiries, safeguarding meetings and investigations.
- Keep referring agencies informed of progress and outcomes.
- Monitor information-sharing practice.
*MARAC: A multi-agency risk assessment conference is a means of coordinating risk based responses to domestic abuse. 
**MAPPA: multi-agency public protection arrangements assess and manage the risks posed by sexual and violent offenders. 
Joint training and policy development
- Increase knowledge and understanding of multi-agency procedures.
- Agree common language, terms and definitions.
- Bring together people from different organisations to develop shared perceptions of risk.
- Improve understanding of the different roles and responsibilities of safeguarding partners to reduce negative attitudes.
- Ensure all staff understand the basic principles of confidentiality, data protection, human rights and mental capacity in relation to information-sharing.
- Ensure designated adult safeguarding mangers play a role in providing advice and guidance within their respective organisations.
View SCIE’s Social Care TV film, Lessons from the murder of Steven Hoskin.
Case study: Lessons from the North Yorkshire serious case review concerning ‘Robert’ Open
Robert’s situation dramatically demonstrated the problems caused by different definitions of vulnerability. He was a young, long-term rough sleeper. His first contact with agencies was when he requested support from a day centre for homeless people. He had been living in a tent, but due to ill health and the winter conditions he could no longer manage.
Staff at the voluntary homeless shelter continually stressed Robert’s level of vulnerability but this did not appear to have been fully understood or acknowledged by the out-of-hours housing service. His care needs were overshadowed by a focus on his eligibility under homelessness legislation. Both housing and social services failed to sufficiently acknowledge the concerns of the homeless shelter and primary health care staff. Duties to assess vulnerable people in need of care and support under both housing and community care legislation were not fully considered. The response by housing and care agencies was highly focused on eligibility for service and there was no evidence of a joint approach to meeting Robert’s needs.  Two weeks after making contact with agencies, in January 2012, he died from morphine intoxication.Learning points
As a result of this case the following recommendations have been implemented: 
- Ensuring that the emergency duty team has an up-to-date knowledge of eligibility criteria, thresholds for assessment, safeguarding procedures and services available for adults.
- Ensuring that cover over extended holiday periods is sufficiently robust.
- Strengthening working relationships between the housing authority and the local homeless project.
- Increasing awareness of the needs of street homeless people among health services.
- Improving call-handling within the police and the housing authority.
- Additional joint training on rough sleeper-related issues for housing, health and social care staff.
Case study: Alice: the importance of joint working Open
Alice lives in a council flat. She is known to have a hoarding problem but has not previously neglected her own hygiene and health needs. Housing officers have intervened in the past, following concerns raised by neighbours. They have advised Alice that she needs to keep her hoarding under control so that it does not become a fire or health and safety risk.
An immediate neighbour calls the housing office to complain about the smell coming from Alice’s flat. She says that Alice seems increasingly unable to cope and is looking dirty and dishevelled. The housing officer, Don, visits. Alice answers the door and does look dirty and unwell. There are unpleasant odours coming from the flat. Alice does not want to let Don enter.
Don asks Alice why she thinks things might be getting more difficult for her. Alice says that her mother recently died. She was close to her mother, who also used to help her and encourage her to keep the hoarding under control. Alice says she does not mind if Don talks to the local authority safeguarding team. Don’s manager suggests he raises a safeguarding alert with the local authority but when he does so the local authority says that Alice is not eligible for social care services so it cannot provide a safeguarding service. Don contacts social services several times and argues that Alice is vulnerable and at risk; her health and wellbeing are clearly deteriorating. He insists that there is a need for joint working to prevent harm in this case. There is continued reluctance to engage from the local authority which Don finds very unhelpful. He discusses this with his manager.
The manager contacts the local authority safeguarding lead and they agree that a joint visit with a social worker should be arranged. Don and Meiling (the social worker) go to see Alice. The situation has not improved. Alice is still reluctant to allow them access but admits she needs help to get both her hoarding and her self-care under control.
Meiling feeds back to her manager that she thinks this will be a long-term piece of work as she will have to gain Alice’s trust and work with mental health colleagues to try and access support for what appears to be obsessive-compulsive disorder. Meiling’s manager agrees that Alice is vulnerable and has care and support needs and that Meiling should take on the case and work with housing and mental health colleagues.
Alice is offered bereavement counselling and support with managing her hoarding behaviour. Meiling is able to get access to the flat with the mental health support worker and they begin to clear some of the hoarded items with Alice. Alice starts to feel better and responds well. Her hygiene also improves.
- Joint working to support people is likely to lead to more efficient working between services.
- Having a joint working agreement in place may avoid lengthy arguments over responsibilities.
- The statutory guidance makes clear that self-neglect comes within the legal definition of abuse or neglect. It should therefore warrant a safeguarding response if the individual concerned has care and support needs.
- Early intervention is likely to have better outcomes for the individual and it may prevent the need for a higher level of support in the future.
- People can become vulnerable to abuse or neglect at any time due to physical or mental ill health, acquired disability, old age, bereavement or environmental factors.
- When working with people who self-neglect it is often necessary to take time to build up trust.
Visit SCIE’s Self-neglect resources.
Case study: Fiona Pilkington and Francesca Hardwick Open
In 2007 Fiona Pilkington and her disabled daughter, Francesca Hardwick, were found in a burnt-out car after years of experiencing anti-social behaviour and disability hate crime. This case highlighted the failings of the police to identify them as repeat victims and share information. The Independent Police Complaints Commission report  found that police responses to hate crimes were isolated and unstructured. This has led to a number of key changes in the way the police are expected to respond to repeat vulnerable victims.
Following this case, a study of anti-social behaviour call-handling trials found that ‘several forces noted a continued (and deeply ingrained) reluctance to share sensitive information between agencies, based on over-interpretation of the current legislation. Engaging security and data protection lead officers early, particularly if new IT is involved, was therefore felt to be critical to the success of the call handling approach’. 
Police and other partners should: 
- have an effective call-handling system
- log information from the very first call
- assess the risk to victims early in the call-handling process
- use IT that enables information-sharing between agencies
- agree a joined-up approach to managing cases
- have a robust community engagement process
- focus on the harm to victims through a sophisticated understanding of what is happening locally.
False perceptions about needing evidence or consent to share safeguarding information
Some frontline staff and managers can be over-cautious about sharing personal information, particularly if it is against the wishes of the individual concerned. They may also be mistaken about needing hard evidence or consent to share information. The risk of sharing information is often perceived as higher than it actually is. It is important that staff consider the risks of not sharing safeguarding information when making decisions.
How to address false perceptions
- Raise awareness about responsibilities to share information (profession- or work role-specific guidance may help).
- Encourage consideration of the risks of not sharing information.
- Brief staff and volunteers on the basic principles of confidentiality and data protection.
- Improve understanding of the Mental Capacity Act.
- Provide a contact number for staff and volunteers to raise concerns.
- Be clear in procedures about when to raise a safeguarding concern.
- Assure staff and volunteers that they do not necessarily need to have evidence to raise a concern.
Case study: Tammy Open
Tammy has mental health problems. She visits the GP for a routine check on her medication. While there, she mentions that her partner is violent towards her. The GP expresses concern and Tammy says that it’s nothing to worry about and in any case it’s no wonder he hits her as she’s very annoying. The GP says that she probably isn’t and even if she is, that doesn’t mean she deserves to be hit. Tammy says she doesn’t want to talk about it anymore and doesn’t want the GP to tell anyone.
The GP is mindful of his duty of confidentiality to the patient. He knows that Tammy has no children, and he does not think that she lacks the capacity to make decisions about living with her partner. He decides that it is her right to make the decision to not tell anyone about the violence, but he does make a note on her file about what she has said.
The next time Tammy comes to the surgery she sees a different doctor. This GP has not seen the note on Tammy’s file about the disclosure. Tammy has a bruise on her face; she says she fell over and that her jaw is very painful. The GP sends her to the hospital for an X-ray and it turns out she has a broken jaw. She has treatment from the hospital. The hospital staff do not question Tammy’s account of the cause of her injury.
A few weeks later Tammy calls the police. Her partner has cut her arm open with a knife and is threatening to kill her.
When deciding whether to share information against someone’s wishes:
- consider whether they have the mental capacity to make the decision and can fully understand the possible consequences
- establish whether coercion or duress is involved – this may warrant sharing information without consent
- enquire about the frequency and seriousness of the abuse
- use gentle persuasion, explain what help and/or protection might be available
- talk to other safeguarding partners without disclosing identity in the first instance
- make enquiries to establish whether the alleged perpetrator has care and support needs or is a carer
- follow up on discussion or disclosures.
Safeguarding vulnerable adults - a tool kit for general practitioners
24-hour National Domestic Violence Freephone Helpline 0808 2000 247 run in partnership between Women’s Aid and Refuge
Complex networks between safeguarding partner agencies
The local authority has the lead responsibility for safeguarding adults with care and support needs, and the police and the NHS also have clear safeguarding duties under the Care Act 2014. Clinical commissioning groups and the police will often have different geographical boundaries and different IT systems. Housing and social care service providers will also provide services across boundaries. This makes sharing information complex in practice.
The Care Act 2014 (Section 6 ) places duties on the local authority and its partners to cooperate in the exercise of their functions relevant to care and support including those to protect adults. The safeguarding adults board should ensure that it ‘has the involvement of all partners necessary to effectively carry out its duties’. 
Addressing problems caused by complex networks:
- Agree clear communication channels at the safeguarding adults board and set them out in the strategic plan.
- Develop partnership working between neighbouring local authorities.
- Set up forums for partners that feed into the safeguarding adults board (e.g. people with care and support needs, carers, housing, service providers and regulators
- develop shared databases that can identify people who may be at risk of abuse).
- Be clear about responsibilities for self-funders and people for whom services are provided outside their local area.