Escalation Pathway
Introduction
Appropriate challenge and escalation are an essential part of partnership working and key to ensuring accountability and achieving positive outcomes for adults at risk. All workers should feel able to constructively challenge decision making and to see this as their responsibility in developing and promoting person centred safeguarding practice, as well as multi-agency working.
We know that good relational practice is an essential tool of multi-agency working. To support this, our policy is to seek to resolve disagreements at the earliest stage possible to ensure the adult at risk 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.
The process outlined in this document relates to situations where there are professional differences of opinion on the approach to safeguarding an adult with care and support needs. It should not be confused with the process to be followed when raising a safeguarding adults concern for consideration of whether to undertake a safeguarding enquiry under Section 42 of the Care Act 2014.
There may also be occasions when the local authority and partners use powers to make proportionate, enquiries outside of the s42 statutory safeguarding duty.
This policy is complemented by our key messages for approaching professional disagreements in adult safeguarding practice:
When challenge may be appropriate
On occasion, there may be cause to challenge the decisions of colleagues and partner agencies. This may include disagreements on:
- Adult safeguarding concerns/enquiries where there are differing opinions, included whether criteria to undertake enquiry is met.
- Lack of engagement of key partners in the multi-agency risk management process, including ineffective communication or disagreement about the sharing of information.
- Misunderstanding regarding respective roles and responsibilities.
- Lack of progression of action plans in response to risk or case closure.
- Professionals disagreeing as to whether an adult has the mental capacity to make a specific decision at that time in relation to the safeguarding intervention.
The above list is not exhaustive. Practitioners should seek advice from their line manager, safeguarding lead and legal advice where there may be a difference in opinion.
This pathway is intended to complement existing processes within and between organisations to respond when adults at risk, their representative, carer or family member raise concerns (or complaints) that statutory responses have not reduced or removed risk in a person-centred way. Therefore, matters relating to eligibility for treatment, care and support and funding arrangements, individual practitioner performance, or complaints about the involvement/conduct of an organisation are not covered within this policy and should be addressed via the relevant agency’s formal complaints procedures.
Where concerns relate to colleagues in a position of trust who may pose a risk to adults with care and support needs, this should be addressed via the Persons in Positions of Trust Framework and in line with respective organisational HR processes.
There may also be times where there is a need to escalate cases where attempts to address risk via usual multi-agency discussions have been unsuccessful and the adult, or others around them, remain at a high level of risk. Such cases should be referred to the most appropriate multi-agency panel within Hammersmith & Fulham. Details of the different panels operating in our borough and how to refer can be found of the H&F Website (including the High-Risk Panel, Cuckooing Risk Panel and Multi-Agency Risk Assessment Conference (MARAC)). Panel chairs can escalate any concerns regarding barriers to effective interventions or drift in risk resolution arising from those case discussions directly to the strategic leaders and to relevant partnerships, including H&F SAB Chair.
Approaching professional disagreement
The below stages outline the process which should be followed to escalate and resolve professional disagreements.
Practitioners responding to a professional disagreement must act in a timely way to ensure an adult’s welfare is the main consideration. The emphasis is always on resolving any dispute at the earliest stage and we must never leave an adult at risk of immediate harm whilst the disagreement is being escalated.
At all stages any challenge must be respectful and retain a professional approach. 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 and public law.
Where the disagreement relates to differences in opinion about a best interests decision made for a person who lacks mental capacity to make that decision themselves, reference should be made to Chapter 15 of the Code of Practice to the Mental Capacity Act 2005.
Expectations
Practitioners should seek to ensure that the adult at risk is at the centre of the process at all times, their voice is heard and that their views and wishes are informing the actions being taken.
At all stages of the escalation process, actions and decisions must be timely, recorded in writing and shared with relevant practitioners, including the worker who initially raised the concern.
Recordings should include views of all involved agencies, confirmation of any agreed outcomes and the timescales for responses to the disagreement.
If the escalating organisation does not receive a response or requires a quicker response due to the safety of the adult, it is their responsibility to make all reasonable proactive contact with the organisation to ascertain the availability of the relevant supervisor/ line manager/ team manager within the organisation.
If the process highlights gaps in policies and procedures this must be brought to the attention of the Chair of the Hammersmith & Fulham Safeguarding Adults Board in order to seek assurance that this will be addressed by relevant agencies.
Escalation process
Initial attempts by involved practitioners should be taken to resolve the problem. This should be done via discussion and/or professionals meeting within one working week.
RESOLVED
- Put outcomes in writing to ensure shared understanding of agreed actions
- Note agreed actions on adult’s case records
- Follow agency procedure for logging disputes or disagreements
- Check back to ensure agreed actions have been fully implemented within agreed timescales
UNRESOLVED
Move to Stage 2.
If resolution has not been possible, any practitioner who feels that a decision is not safe or is inappropriate should consult with their line manager. There may also be instances where disparity in perceived status or experience may inhibit the ability of some workers to resolve the disagreement without support.
Line managers should liaise with the equivalent representative in the partner agency and seek to review available information and discuss situation in order to resolve disagreement.
Advice may also be sought from legal services or safeguarding leads within respective agencies, as required, at this stage.
RESOLVED
- Complete all actions outlined above and;
- Notification of the dispute and outcomes should be provided to the relevant agencies’ designated safeguarding leads.
UNRESOLVED
Move to Stage 3.
If disagreement remains unresolved this should be escalated without delay though the line management structures of respective agencies. Senior managers should seek to resolve the disputes within one working week.
Where attempts to address risk via usual multi-agency discussions have been unsuccessful and the adult, or others around them, remain at a high level of risk, referrals should be made to the High-Risk Panel.
RESOLVED
- All actions outlined above, and;
- Notification of the dispute and outcomes should be provided to the relevant agencies’ designated safeguarding leads.
UNRESOLVED
Move to Stage 4.
If prior attempts to resolve the dispute have not been successful, escalation should be made to the relevant Hammersmith & Fulham Safeguarding Adults Board member for the respective organisation in order to arrange a resolution meeting. This will be chaired by a statutory member of the Safeguarding Adults Board with appropriate seniority (equivalent to Director or Detective Superintendent) and will invite the participation of senior managers with operational responsibility for the case.
RESOLVED
- All actions outlined above, and;
- Outcome of meeting and agreed actions to be confirmed in writing and consideration given to where the record of the meeting is to be held.
- Senior managers consider the need to review policies or procedures, or to address any compliance or professional competence issues.