Procedure Title - Escalating Concerns Procedure Management ...

Procedure Title - Escalating Concerns Procedure

Definition: Procedure – An agreed method or approach to comply with Policy, Legislation and Departmental Decisions.

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Management Information Lead Officer Name: Colin Beck

Designation: Manager - Mental Health, Criminal Justice and Substance Abuse

Tel: 553 8200 (x 58200) Lead Service Area Mental Health, Criminal Justice and Substance

Abuse Date Agreed 12 November 2015 Last Review Date n/a Next Review Date 12 November 2016 Agreed by Adult Protection Committee Has Screening for Equality Impact been undertaken for this procedure?

Yes/No: No Date: n/a

Has Implementation and Monitoring been considered for this procedure?


If appropriate, has Health and Safety section had oversight of this procedure?


Name of Health and Safety contact

n/a

https://orb.edinburgh.gov.uk/downloads/file/9541/screening_for_equality_impact_form_0005

https://orb.edinburgh.gov.uk/downloads/file/9541/screening_for_equality_impact_form_0005

https://orb.edinburgh.gov.uk/downloads/file/2387/form_0006-policy_and_procedure_implementation_and_monitoring_tool

https://orb.edinburgh.gov.uk/downloads/file/2387/form_0006-policy_and_procedure_implementation_and_monitoring_tool



Authorised by: [Adult Protection Period] Original Issue: [12 November, 2015]

Lead Officer: [Colin Beck, Senior Manager - Mental Health, Criminal Justice] Current Version: [1]

Review Date: [12 November, 2016] of 14 Document [131]

1. PURPOSE ‘Inclusive Edinburgh’ is evaluating how effectively statutory and voluntary services manage risk. This procedure is a product of the work being done within Inclusive Edinburgh and is based on an evaluation of the pilot Escalating Concerns Forum in 2014. It does not propose the creation of a regular forum. It encourages partner agencies to convene local multi-agency case discussions to develop risk management plans as required. Where the risk cannot be managed locally, a review carried out by senior managers known as the Escalating Concerns Group can be requested.

2. SCOPE 2.1 The significant case review "Not my problem" (Mental Welfare Commission, 2007)

highlighted the risks resulting from agencies turning individuals away or failing to engage with them effectively because they do not fit the criteria of a particular service.

2.2 There are individuals who are often well known to public agencies, including emergency services, who are not adults at risk as defined by the Adult Support and Protection (Scotland) 2007 Act (ASP), but who are at risk of harm, including individuals who:

• self-harm repeatedly, but are not admitted to hospital

• challenge social care supports by presenting risks to self or others, which cannot be managed or contained by environmental restraints

• place themselves and others at risk from fire

• for historical social / emotional reasons, have low self-esteem and repeatedly engage in risky behaviour, often compounded by substance misuse

• have dangerous behaviours, which fall out with MAPPA, Mental Health legislation, etc., and which make them hard to support or leave them unsupported in the community.

2.3 The most effective and valued aspect of the adult support and protection process is the multi-agency consideration of risk and the sharing of responsibility for the support and protection of individuals. Many agencies recognise the value of this process and seek to present the person with whom they are working as an “adult at risk”.

2.4 The electronic Initial Referral Discussion (eIRD) and current adult protection process compel staff to confine IRDs to those adults who meet the three point test. Whilst it is necessary to have some boundaries and thresholds, this restriction is not always helpful in terms of the broader adult protection context and the need to share information about risk.

2.5 The adult support and protection framework provides an effective means to consider and manage risk, and could be replicated to support the agencies to deal with those complex cases that require adult protection in its broader form.






3. DEFINITIONS ASP - Adult Support and Protection

eIRD - Electronic Initial Referral Discussion

EVOC - Edinburgh Voluntary Organisations’ Council

MAPPA - Multi-agency Public Protection Arrangements

MARAC - Multi-agency Risk Assessment Conference

RMCC - Risk Management Case Conference

SFRS - Scottish Fire and Rescue Service

4. ACTIONS 4.1 The purpose of this model is to explore solutions, legislative and service options at

a locality (operational) level in the first instance.

4.1.1 To minimise risks to the individual and/or from the individual, through a partnership approach. This will be achieved by encouraging front line services to explore innovative solutions and legislative and service options. They will develop a shared risk management plan which acknowledges the rights of the individual to make poor choices, where these do not affect the rights or choices of others. The partnership approach will also improve understanding of respective agency roles, legislative options and the limits of these.

4.1.2 To encourage innovative ways of working within and across service boundaries in the interests of risk management.

4.1.3 To provide a strategic analysis of gaps in service provision for people with significant levels of unmanaged risk. By doing so the process may identify gaps in resources, systems and knowledge.

4.1.4 To share responsibility and to support agencies and front line staff who deal with crises and chronic situations of risk, and not simply pass the responsibility to a single agency.

This procedure will not replace agency referral or legal process, and will not be used as a referral short cut or as a means to pass responsibility to a single agency.

4.1.5 The Escalating Concerns Procedure does not replace locality inter-agency management of adults at risk or adults subject to the adult support and protection process. The intention is to build on a culture of partnership working to manage risk, and in cases which continually fall below the threshold of the legislation to identify them as having a level of extraordinary challenge, which requires the intervention of senior managers. The Escalating Concerns Group will be a static group and comprise senior managers identified by the directors of respective agencies. These will be of sufficient seniority to identify and allocate resources.






4.1.6 This process should also facilitate a greater understanding of respective duties and legal powers, and more significantly, the limits to these. A common thread in significant case reviews is the misunderstanding by agencies of each other’s roles and responsibilities and of the unrealistic expectations of legal options to intervene.

4.2 Principles

4.2.1 All interventions will be the least restrictive option that will provide proportionate benefit to the person.

4.2.2 The importance of the adult participating as fully as possible in the process. This includes:

• keeping the person informed of the process as far as it pertains to them

• supporting the person to participate in meetings

• assisting the person with any communication needs they might have

• making the person aware of advocacy services they may be eligible for and supporting them to link into those services.

4.3 Operational level - Getting it Right Meeting

4.3.1 Level 1 (single agency) and level 2 (multi-agency) risk management will continue where this is a proportionate response to manage risk. All multi-agency representatives are expected to give due consideration to requests from partner agencies to explore how to manage risk jointly. These risk conversations are already happening in some areas.

4.3.2 If the concern represents extraordinary challenges which cannot be managed under existing risk management frameworks (eg. MAPPA, MARAC, ASP, RMCC) the manager of the front line worker in the agency (or someone delegated within that agency on their behalf) which identifies the need for a multi-agency risk management plan will co-ordinate a ‘Getting it Right’ meeting. They will also arrange for someone to chair the meeting (usually the manager within the agency raising the concern) and complete and circulate the risk management plan.

4.3.3 This will encourage a partnership approach which promotes the shared management of risk and an improved understanding of respective agency roles, legislative options and the possibilities within the limits to these.

4.3.4 There is an expectation that the front line worker or first line managers from partner agencies will attend the ‘Getting it Right’ meeting. The relevant Health, Council, Police, Fire and 3rd sector services will be invited even where there is no current involvement but their expertise is required. If the person raising the concern cannot attend then it is their responsibility to arrange for someone within their organisation to do so. For the purposes of this procedure GPs would have to negotiate a delegate from within NHS Lothian if they were unable to attend.

Agencies are required to be as collaborative and innovative as possible within their own settings and in relation to their practice with partner agencies in order to assist in the management of risk.






4.3.5 The shared risk management plan arising from this process should be recorded formally by partner agencies, as with child and adult protection plans. It should also be recorded that a ‘Getting it Right’ meeting has taken place. Therefore, there will be a recording of the ‘Getting it Right’ risk management plan on all of the partner agency’s systems like Swift, Housing Information System, TRAK etc.

4.3.6 The risk management plan must be reviewed. Agreement should be reached at the Getting it Right meeting when the next review will be. This must be carried out by the full ‘Getting it Right’ meeting at least every six months. It will also agree who are the most appropriate staff to form a Core Group and how often they meet to monitor the effectiveness of the risk management plan between full formal reviews of the ‘Getting it Right’ meeting. Membership of the Core Group will normally be drawn from the ‘Getting it Right’ meeting.

4.3.7 In some cases, options for managing risk at the operational level will have been exhausted. The agencies feel that there is no local resolution and a significant risk continues and agree to the Chair of the ‘Getting it Right’ meeting making a referral to the Escalating Concerns Group (using template) via their senior agency representative on that group. Referral will either be accepted for consideration by the Escalating Concerns Group or returned with advice and recommendations. Co-ordinators who are considering the need to escalate a case for review by the Escalating Concerns Group are encouraged to identify in the referral the local innovative, integrated and assertive approaches developed in an attempt to manage the risk. They are also encouraged to identify in the referral any innovative, integrated and assertive approaches to manage risk that require the authorisation of the Escalating Concerns Group.

4.3.8 The senior agency representative on the Escalating Concerns Group that made the referral to the group will respond to the referrer within two working days. This response will either arrange for local staff teams to continue to manage the risk or that the senior manager will convene a meeting of the Escalating Concerns Group.

4.4 Escalating Concerns Group Membership (Strategic)

Members will be at senior manager level who have a strategic overview and can allocate resources. Their membership should be agreed by the director of their service, and will be drawn from:

• Social Work

• Services for Communities

• NHS Lothian

• Police

• the voluntary sector (e.g. chair of EVOC)

• other key individuals as appropriate in order to support the scrutiny of the referral.






5. RESPONSIBILITIES Roles and Responsibilities of the Escalating Concerns Group

The Escalating Concerns Group will scrutinise the referral to establish that options for managing significant levels of risk locally have been exhausted.

The Escalating Concerns Group is convened as required as described above. Members are nominated senior managers from partner agencies. The voluntary sector and Scottish Fire and Rescue Service will attend as appropriate.

The role of the Group is to analyse the concern and agree necessary action in respect of the person under consideration. A principle of this procedure is to foster innovative approaches to risk management and this group should be in a position to allocate resources and identify patterns and issues to inform service design.

6. POLICY BASE Risk Assessment Policy (HSC)

7. ASSOCIATED DOCUMENTS Appendix 1 - Escalating Concerns Flowchart (Operational)

Appendix 2 - Getting It Right Case Conference

Appendix 3 - Getting It Right Case Conference Agenda

Appendix 4 - Getting It Right Case Conference – Risk Management Plan (Form 0062)

Appendix 5 – Data Sharing Agreement (awaiting publication)

Appendix 6 - Inclusive Edinburgh Report

8. RECORD KEEPING When a procedure has been followed there are often outputs such as decisions made or events occurred

that need to be recorded. These outputs are considered Council records. Please list all Records, including completed forms, generated by this procedure. For each record, list its title, location, responsible officer and minimum retention period.

Record Title Location Responsible Officer

Minimum Retention Period

Getting It Right Meeting

H&SC: Swift Senior Social Worker/Occupational Therapist

As Case File retention period

Getting It Right Meeting

Services for Communities: Housing Information System

Senior Housing Officer

As Case File retention period

https://orb.edinburgh.gov.uk/downloads/file/4660/risk_assessment_policy

https://orb.edinburgh.gov.uk/downloads/download/8506/form_0062-getting_it_right_case_conference

http://www.edinburgh.gov.uk/info/20029/have_your_say/948/inclusive_edinburgh






Appendix 1






Appendix 1 (con’t)






Appendix 2

Getting it Right Case Conference:

Guidance Notes

Please read the Escalating Concerns Procedure before deciding whether to proceed with a ‘Getting it Right’ case conference. This will support you in deciding whether a ‘Getting it Right’ case conference is the appropriate way forward.

Principles:

As per the Escalating Concerns Group all interventions in the person’s life should be guided by the following principles:

All interventions in the person’s life will be the least restrictive option that will provide proportionate benefit to the person.

The importance of the adult participating as fully as possible in the process. This includes:

keeping the person informed of the process

supporting the person to participate in meetings

assisting the person with any communication needs they might have

making the person aware of advocacy services they may be eligible for and supporting them to link into those services.

A ‘professionals only’ section of the meeting should be held to cover Third Party confidential information. This and any risk management relating to this should be recorded separately.

1. You have decided that a ‘Getting it Right’ case conference is the most appropriate way to manage risk. Participants are encouraged to be innovative and collaborative in their approaches to manage risk (see ‘case examples’ for further information). The purpose of the ‘Getting it Right’ case conference is to agree:

• a risk management plan

• a timescale for review by the full Getting it Right case conference (minimum every six months)

• the membership of the ‘Core Group’ to monitor the progress of the plan between reviews, and

• how often the core group should meet.

2. As the agency requesting a ‘Getting it Right’ case conference you are responsible for:

• coordinating the meeting

• completing and circulating the risk management plan, giving recipients two weeks maximum to respond with corrections

• arranging the Chair for the meeting. This will usually be a manager from the referring agency.

3. Prior to having the discussion at the ‘Getting it Right’ case conference please ensure all invitees who are already involved are asked to consider the following six key questions:

3.1. What is the person saying about the situation?






3.2. What is getting in the way* of the person’s wellbeing? (*please think of the barriers in a broad sense, including factors like organisational criteria / policies / procedures / culture that may be getting in the way). This may or may not mean that risk would be better managed if your organisation and/or another organisation operated in a different way. The point is to determine if there is something that could be done that would assist in risk management that is not currently being done. This will inform whether an innovative and collaborative approach will sufficiently manage the risk or whether the concern needs to be escalated to the Escalating Concerns Group.

3.3. Do I have all the information I need to help this person?

3.4. What can I do now to help this person?

3.5. What can my agency do to help this person?

3.6. What additional help, if any, may we need from others?

At the meeting please, as per item 7 on the Getting it Right meeting agenda, address the concerns to the ‘Living-Well’ triangle.

In compiling the ‘Getting it Right’ Risk Management Plan please ensure that the plan assists the person, as much as possible, to meet the Getting it Right goals. The Chair is responsible for reviewing the plan at the meeting to ensure it addresses the goals. That is, for everyone to be:

Safe: - protected from abuse, neglect or harm at home, at work, or in their community

- protected from causing harm to others or themselves.

Healthy: - having the highest attainable standards of physical and mental health

- having access to suitable health and dental care

- supported to have or make healthy and safe choices

- being enabled to make healthy diet choices.

Achieving: - having opportunities and support to continue to learn and develop skills throughout life

- being confident about themselves and having positive self-esteem.

Nurtured: - having a safe, secure and comfortable place to live where people look out for them.

Active: - having opportunities to take part in activities, such as sport and recreation activity, which contribute to health and wellbeing.

Respected: - having the opportunity to be heard and involved in decisions that affect them.

Responsible: - having opportunities and being supported to take an active and responsible role in their own lives, and in their communities.

- being enabled to make decisions about things that affect them.

Included: - having help to overcome social, educational, physical and economic inequalities and being accepted as part of the communities in which they live, work and learn.






Appendix 2 (con’t)

Risk

Management

Plan






Appendix 3

Escalating Concerns Procedure:

GETTING IT RIGHT CASE CONFERENCE AGENDA

Person(s) to be discussed:

Date:

Venue:

1. Introductions

2. Reminder re. restricted information sharing

3. Apologies

4. Reasons for this Getting it Right Case Conference

5. Information from reports

6. Person’s views and wishes

7. My World Triangle Discussion

8. Risk assessment

9. Statutory measures in place

10. Further assessment required under ASP, AWI or MH Act?

11. Risk Management Plan

12. Core group membership

13. Date of next core group meeting

14. Date of review






Appendix 4

Procedure Title - Escalating Concerns Procedure Management ...

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