5.5 Escalation and Resolution Protocol

1. Introduction

This Escalation Protocol should only be used within safeguarding practice, not for other matters, such as assessment for more general care and support needs, eligibility for care and support and funding of care and support needs: these are outside the scope of this process. Individual practitioner performance is also outside the scope of this document. The adult subject to the safeguarding concern and/or their representative should, wherever possible, be aware of the dispute and have an opportunity to express their views and wishes, in particular, that in raising a dispute, the worker has full consideration of the adult’s wellbeing.

Disagreements could arise in a number of areas, but are most likely to arise around:

• Adult safeguarding concerns/enquiries where the threshold for intervention is contested;
• Concerns about agency adult safeguarding case management;
• Lack of engagement of key partners in the multi-agency risk management process;
• A lack of understanding regarding respective roles and responsibilities;
• An absence of action/ case closure;
• The views of the adult and/ or their representative being at odds with professionals / agencies views/ and or where it places the adult at on-going risk of harm.

2. Legal Context

The Care Act 2014 and Chapter 14 of the Care and Support Statutory Guidance includes six key principles that underpin safeguarding adults practice, these are:

• empowerment;
• prevention;
• proportionality;
• protection;
• accountability; and
• partnership.

All partner agencies and their staff are accountable for delivering their part of the adult safeguarding process to a high standard. This protocol applies to all partners including Adult Social Care, Police and Health, housing, voluntary sector and any other professionals supporting adults experiencing or at risk of abuse and neglect. This Protocol should only be used by exception and should not replace other multi-agency pathways.

The process outlined in this Protocol relates to cases where there are safeguarding concerns that meet the statutory threshold under section 42 of the Care Act 2014. The threshold for triggering the local authority’s duty to carry out an enquiry, or cause others to do so, is when the local authority has reasonable belief that an adult in its area has:

• care and support needs, and
• is experiencing, or is at risk of abuse or neglect, including some aspects of self-neglect, and
• as a result of care and support needs, it appears that he or she is unable to protect themselves from the risk of, or experience of, abuse or neglect.

3. Stages of the Protocol

See also, Escalation and Resolution Protocol Flowchart (opens as a PDF)

At each stage, the practitioner initiating the issue/challenge must, wherever possible, involve the adult and / or their representative in order to ascertain and ensure that the proposed actions/ areas of concern/dispute are understood and do not conflict with/ impact upon the adult’s independence, wellbeing and / or decisions/outcomes they want to achieve.

At all stages of escalation, records of discussions and any decisions made should be recorded in writing and shared with any relevant personnel. The BSAB does not prescribe a specific reporting format, but a template is available which may be useful (see Appendix A).

Stage One

When there is a disagreement about actions and decisions, initial attempts to resolve the problem should be made between partner agency practitioners. It should be recognised that differences in status and/or experience may affect the confidence of some workers to pursue this without support. However, all members of staff have a professional duty to raise concerns about the safety and well-being of adults and carers and to act promptly. There should be an open discussion where the disagreement is communicated, with the purpose of resolving the matter at this level.

This stage should be complete within five working days.

Stage Two

Any practitioner who feels that a decision is not safe or is inappropriate, and/or where it has not been possible to reach a resolution through Stage One, must escalate their concern as soon as possible to the relevant supervisor/manager. The practitioner should clearly and explicitly communicate what the disagreement is about and advise what outcome is required.

The relevant line manager/supervisor should then raise the concerns with the equivalent supervisor/manager in the other agency/organisation. This can also be direct to the manager who made the decision, for example chair of a safeguarding planning meeting.

This stage should be complete within three working days.

Stage Three

If the problem is not resolved at stage two, the respective supervisors/managers must escalate the concern to their senior managers e.g. Deputy Director of Nursing, local authority Adults Safeguarding Manager and Trust Named Professional. An equivalent process to Stage 2 should take place at this higher management level.

This stage should be complete within two working days.

Stage Four

In exceptional circumstances, where there is failure to resolve disagreements amongst managers within agencies using the previous processes, the matter must be referred to the relevant Head of Service, Director of Nursing/Safeguarding, Designated Safeguarding Lead for the ICB/NHS Trust and the Chair of the relevant LSAB. They must be prepared, where necessary, to intervene and this might also be relevant if discussions raise significant protocol issues.

This stage should be complete within one working day , n the absence of which the DASS remains legally responsible for the resolution outcome.

4. Good Practice Examples

Buckinghamshire Safeguarding Adults Board is committed to the principle that appropriate challenge and escalation is an essential part of partnership working and professional responsibilities to achieve high standards. On occasion, this may necessitate challenging practice when staff in one agency have concerns about the way in which staff within another agency are delivering their practice. In such circumstances, there must be a respectful challenge about the action or inaction taken. Appropriate challenges and escalation is vital to delivering continuous improvement, ensuring both accountability and partnership working as well as for achieving good outcomes for adults with care and support needs.

It should be clear how to escalate concerns about decisions made and actions taken or proposed where these cause concerns about safeguarding practice. Those challenged should retain a professional approach and avoid becoming defensive if a concern is raised about their practice or decision making. Practitioners and managers should always be prepared to review decisions and plans with an open mind and act proportionately and in accordance with the principles underpinning Making Safeguarding Personal (see Making Safeguarding Personal chapter).

Primacy is always accorded to the wishes and preferences of the adult affected by any safeguarding concern. One of the key principles of adult safeguarding work is that adults may have the right, and may exercise the right, to make unwise high-risk decisions. As long as they have mental capacity to do so, their wishes must be accorded primacy by all professionals involved.

Problem resolution is an integral part of professional co-operation and joint working to safeguard adults. The safety of adults experiencing or at risk of abuse or neglect and/or the impact on the adult’s wellbeing must be the paramount consideration in any professional disagreement. Unresolved or contested areas should be addressed with due consideration to the risks that might exist for the adult as well as taking into account the adult’s views and wishes and desired outcomes, where known.

All practitioners should feel able to challenge decision making and to see this as their responsibility in developing and promoting person-centred safeguarding practice. This Protocol provides workers with a structure by which concerns they have about decisions made by other practitioners/professionals in partner agencies can be raised. The Protocol aims to:

• resolve difficulties within and between agencies quickly and openly;
• promote resolution and development; and
• ensure that the adult experiencing or at risk of abuse or neglect is at the centre of the process, that their voice is heard.

Effective partnership working depends on an open approach and honest and positive relationships between the adult experiencing or at risk of abuse or neglect and other workers/agencies.  The resolution of problems and challenges are integral to effective professional co-operation and joint working to safeguarding adults at risk.

Resolution should be sought within the shortest timescale possible to ensure the adult experiencing or at risk of abuse and neglect has a proportionate level of response, promoting the wellbeing of the adult and taking full account of their views and wishes and/or where appropriate, their representative. Disagreements should be resolved at the earliest possible stage, however if an adult is thought to be at risk of immediate harm, discretion should be used as to which stage is initiated.

5. Complex High-Risk Cases

Where there are significant and serious areas of disagreement between local authority adult social care, police and health, resulting in polarised views, it can be difficult to reach agreement. Where time pressures, particularly within or about acute health service issues are involved, it is proposed that multi-agency oversight of the case involving senior staff is undertaken early on by convening a round-table discussion or consultation involving senior managers. This group would agree and propose actions to be communicated directly to the operational staff involved. This should seek to resolve the matter promptly or propose how disagreements would be considered and resolved further.

6. Concerns about the Practice of Colleagues in your own Organisation

Each agency should have its own clear and accessible guidance in respect of ‘whistleblowing’ which should be consulted where there are serious concerns about the practice of a colleague which have not yet been resolved by discussion with the relevant managers. If you have exhausted your organisation’s whistleblowing process you should escalate outside the organisation. See Whistleblowing chapter for more information.

Concerns relating to colleagues in a position of trust believed to pose a risk to adults with care and support needs should be addressed using their organisational Allegations Management Framework and in line with respective HR processes. Concerns relating to criminal matters must be referred to the police. If the process highlights gaps in policies and procedures this should be brought to the attention of the Independent Chair of the Safeguarding Adults Board.

See also Framework for the Management of Allegations against People in Positions of Trust (PiPoT).

Appendix A – Record of Escalation, Challenge and Conflict Resolution between Practitioners or Agencies

Agencies should use the template contained in the Record of Escalation, Challenge and Conflict Resolution between Practitioners or Agencies (opens in Word) from Stage Two onwards.